# JENNIE M MELHAM MEMORIAL MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Jennie M. Melham Memorial Medical Center-LTC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093880072
- **Authorized official:** MR. TIMOTHY L SCHUCKMAN (VICE PRESIDENT-CFO)
- **Authorized official phone:** (307) 872-2625

## Contact information

- **Practice address:** 145 MEMORIAL DR, BROKEN BOW, NE 68822-1378
- **Practice address phone:** (308) 872-2625
- **Practice address fax:** (308) 872-6116
- **Mailing address:** PO BOX 250, BROKEN BOW, NE 68822-0250
- **Mailing address phone:** (308) 872-2625
- **Mailing address fax:** (308) 872-6116

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | LTCH004 | NE | Yes |

## Other

- **Enumeration date:** 11/22/2006
- **Last updated:** 01/10/2020