Provider Demographics
NPI:1801917380
Name:LITZENBERG MEM CNTY HOSP PHCY
Entity type:Organization
Organization Name:LITZENBERG MEM CNTY HOSP PHCY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:REGINALD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RP
Authorized Official - Phone:308-946-5981
Mailing Address - Street 1:1715 26TH ST
Mailing Address - Street 2:RR2 BOX 1
Mailing Address - City:CENTRAL CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68826-9501
Mailing Address - Country:US
Mailing Address - Phone:308-946-5981
Mailing Address - Fax:308-946-5911
Practice Address - Street 1:1715 26TH ST
Practice Address - Street 2:RR2 BOX 1
Practice Address - City:CENTRAL CITY
Practice Address - State:NE
Practice Address - Zip Code:68826-9501
Practice Address - Country:US
Practice Address - Phone:308-946-5981
Practice Address - Fax:308-946-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336L0003X
NE25513336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2054566OtherPK
2054566OtherPK
NE=========00Medicaid