NPIMap

Organization Active NPI

Heritage of Wahoo, Inc

Doing business as South Haven Living Center

  • Skilled Nursing Facility
  • Wahoo, NE
National Provider Identifier
1467561100
Registry record updated Jul 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
694005 Issued in NE
Legal business name
HERITAGE OF WAHOO, INC
Doing business as
South Haven Living Center
Practice address
1400 Mark Dr
Wahoo, NE 68066-4023
Phone
(402) 443-3737
Fax
(402) 443-5867
NPI assigned
Aug 29, 2006
Last updated
Jul 2, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2008

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

Authorized official

Name
Jack Dean Vetter
Title
President
Phone
(402) 895-3932

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 694005 NE Primary

Addresses

Primary practice location

1400 Mark Dr
Wahoo, NE 68066-4023

Mailing address

1400 Mark Dr
Wahoo, NE 68066-4023
Phone (402) 443-3737

Other names 1

  • South Haven Living Center Doing business as

National Provider Directory

National Provider Directory

Locations

1400 Mark Dr
Wahoo, NE 68066
Phone (402) 443-3737

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1467561100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MARK DR",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680664023",
            "telephone_number": "402-443-3737",
            "fax_number": "402-443-5867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MARK DR",
            "city": "WAHOO",
            "state": "NE",
            "postal_code": "680664023",
            "telephone_number": "402-443-3737",
            "fax_number": "402-443-5867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE OF WAHOO, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "VETTER",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "402-895-3932"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "694005",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Haven Living Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wahoo, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.