Organization Active NPI

Mount Carmel Home Keens Memorial

  • Skilled Nursing Facility
  • Kearney, NE
National Provider Identifier
1073577680
Registry record updated Jun 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
074003 Issued in NE
Legal business name
MOUNT CARMEL HOME KEENS MEMORIAL
Practice address
412 W 18TH St
Kearney, NE 68845-5948
Phone
(308) 237-2287
Fax
(308) 237-7264
NPI assigned
Apr 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tracy Banda
Title
Director of Operations
Phone
(308) 237-2287

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 074003 NE Primary

Addresses

Primary practice location

412 W 18TH St
Kearney, NE 68845-5948

Mailing address

412 W 18TH St
Kearney, NE 68845-5948

Other identifiers 1

IdentifierTypeStateIssuer
00661OtherNEBLUE CROSS BLUE SHIELD

Other names 3

  • Mount Carmel Home- Keens Memorial Doing business as
  • Mt Carmel Home Doing business as
  • Mt Carmel Home- Keens Memorial Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030327000005 NE Part A Provider - Skilled Nursing Facility 7517876741 Practice locations: Kearney, NE

Skilled nursing facility certification: CCN 285216

Legal name
MOUNT CARMEL HOME KEENS MEMORIAL
Doing business as
MT CARMEL HOME - KEENS MEMORIAL
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1997
Last certification
Nov 13, 2024
Beds
75
Ownership / control type
Nonprofit Corporation
Organization structure
OtherNon-profit
Enrollment address
412 W 18TH St
Kearney, NE 68845-5948
Nursing home name
MT CARMEL HOME - KEENS MEMORIAL

Care Compare: Nursing home

Medicare Care Compare
Listed as
Mt Carmel Home - Keens MemorialCCN 285216
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Dec 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7556.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D0455958Mount Carmel Home412 W 18TH Street, Kearney, NE 68845Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Katherine Johnson Individual Corporate DirectorDirector of Nursing Jul 9, 2017
Adp of the SNF Jan 8, 2025
Robert C Messbarger Individual Contracted Managing EmployeeMD; Oct 1, 2020 100%
Adp of the SNF Jan 8, 2025
Mary Therese Blavet Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2016 100%
Corporate Officer Aug 1, 2013
Other Oct 31, 2014
Adp of the SNF Jan 8, 2025
Direct Ownership Interest Jan 1, 2016 4.9%
Tracy Banda Individual Corporate OfficerDirector of Operations Jan 1, 2016 100%
W-2 Managing EmployeeDirector of Operations Feb 28, 2006 100%
Operational/Managerial ControlDirector of Operations Jan 1, 2016 100%
Emily Birdsley Individual Contracted Managing EmployeeAd; Aug 7, 2018
Corporate OfficerAdministrator Feb 4, 2018
Adp of the SNF Jan 8, 2025
Katrina Charles Individual Other Oct 31, 2014

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144800000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1073577680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 W 18TH ST",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688455948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 W 18TH ST",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688455948",
            "telephone_number": "308-237-2287",
            "fax_number": "308-237-7264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT CARMEL HOME KEENS MEMORIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-12",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "BANDA",
        "authorized_official_first_name": "TRACY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "308-237-2287"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "074003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "00661",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Carmel Home- Keens Memorial",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mt Carmel Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mt Carmel Home- Keens Memorial",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kearney, NE

Sources for this page

Verify at the official NPI Registry.