# NORTHEAST NEBRASKA LTC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** VITAL CARE PHARMACY OF NORFOLK, INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1033502950
- **Legal business name:** VITAL CARE PHARMACY OF NORFOLK, INC
- **Authorized official:** MITCHELL E DEINES RP (MEMBER/DIRECTOR)
- **Authorized official phone:** (402) 223-4779

## Contact information

- **Practice address:** 120 N 27TH ST, SUITE 200, NORFOLK, NE 68701-3286
- **Practice address phone:** (402) 371-3444
- **Practice address fax:** (402) 371-3566
- **Mailing address:** 120 N 27TH ST, SUITE 200, NORFOLK, NE 68701-3286
- **Mailing address phone:** (402) 371-3444
- **Mailing address fax:** (402) 371-3566

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336L0003X | Long Term Care Pharmacy | 605 | NE | Yes |

## Other

- **Enumeration date:** 03/17/2015
- **Last updated:** 03/17/2015