STATE OF NEBRASKA ROSTER LONG TERM CARE FACILITIES

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1 STATE OF NEBRASKA ROSTER LONG TERM CARE FACILITIES Nursing Facilities Skilled Nursing Facilities Intermediate Care Facilities Long Term Care Hospitals Department of Health and Human Division of Public Health, Licensure Unit 301 Centennial Mall South-Third Floor PO Box Lincoln, NE Long Term Care Licenses Expire March 31, each year

2 NEBRASKA LONG TERM CARE FACILITIES DEFINITIONS Skilled Nursing Facility means a facility where medical care, skilled nursing care, rehabilitation, or related services and associated treatment are provided for a period of more than twenty-four consecutive hours to persons residing at such facility who are ill, injured, or disabled. Intermediate Care Facility means a facility where shelter, food, and nursing care or related services are provided for a period of more than twenty-four consecutive hours to persons residing at such facility who are ill, injured, or disabled and do not require hospital or skilled nursing facility care. Nursing Facility means a facility where medical care, nursing care, rehabilitation, or related services and associated treatment are provided for a period of more than twenty-four consecutive hours to persons residing at such facility who are ill, injured, or disabled. Long-Term Care Hospital means a hospital or any distinct part of a hospital that provides the care and services of an intermediate care facility, a nursing facility, or a skilled nursing facility.

3 NEBRASKA NURSING HOMES/LONG TERM CARE FACILITIES Licensed Facilities Licensed NURSING FACILITY (LIC) 1 72 SKILLED NURSING FACILITY (LIC) NURSING FACILITY (19) SKILLED NURSING FACILITY (18) 1 42 SKILLED NSG/NSG FAC DISTINCT PART 16 1,779 DUAL CERT , ,756 SPECIAL CARE UNIT Alzheimer 29 LEGEND S/NF DP LTC LTCH SNF LIC LTC NF LTCH SNF LTCH NF NF LIC SNF/ICF S/NF DP SNF-LIC LIC Long Term Care Hospital / Distinct Part Long Term Care Hospital / Dual Long Term Care Hospital / License Only Long Term Care Hospital / Nursing Facility Long Term Care Hospital / Skilled Nursing Facility Nursing Facility (19) - Medicaid Certified Nursing Facility / License Only Skilled Nursing Facility / Intermediate Care Facility Skilled Nursing Facility / Distinct Part - Medicare/Medicaid Distinct Part Skilled Nursing Facility / License Only Skilled Nursing Facility / Nursing Facility - ALL BEDS Medicare/Medicaid Certified Medicare Certified Medicaid Certified License Only Please contact the Licensure Unit or the provider to determine current Medicare/Medicaid status

4 Page 2 of 48 ADAMS (GAGE) Gold Crest Retirement Center 200 LEVI LANE (402) FAX: (402) COFFMAN-LEVI CHARITABLE TRUST, INC JEFF FRITZEN, ADMINISTRATOR MICHELLE DENKER, Director of Nursing Medicare/Medicaid - 52 Total Lic - 52 AINSWORTH (BROWN) Ainsworth Care Center, LLC 143 NORTH FULLERTON STREET (402) FAX: (402) AINSWORTH CARE CENTER, LLC JOHN KLAASMEYER, ADMINISTRATOR KATIE AASE, Director of Nursing c/o: AINSWORTH CARE CENTER, LLC 190 S MAIN STREET, BOUNTIFUL UT Medicare/Medicaid - 46 Total Lic - 46 ALBION (BOONE) Good Samaritan Society - Albion P O BOX 271, 1222 SOUTH 7TH STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY KERRY DAVIDSON, ADMINISTRATOR CHERYL MUSIL, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60 ALLIANCE (BOX BUTTE) Good Samaritan Society - Alliance P O BOX 970, 1016 EAST 6TH STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY JOSEPH SHAFER, ADMINISTRATOR ANN LAJUNE BACON, Director of Nursing Medicare/Medicaid - 77 Total Lic - 77 ALLIANCE (BOX BUTTE) Highland Park Care Center P O BOX 950, 1633 SWEETWATER (308) FAX: (308) ALLIANCE HEALTH CARE, INC. ROBIN POWELL, ADMINISTRATOR TERESA MCFARLAND, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60

5 Page 3 of 48 ALMA (HARLAN) Good Samaritan Society - Colonial Villa 719 NORTH BROWN STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CYNTHIA THOMAS, ADMINISTRATOR STACY NEUBAUER, Director of Nursing Medicare/Medicaid - 53 Total Lic - 53 ARAPAHOE (FURNAS) Good Samaritan Society - Arapahoe P O BOX 448, 601 MAIN STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CYNTHIA THOMAS, ADMINISTRATOR SUE ROBERTS, Director of Nursing Medicare/Medicaid - 30 Total Lic - 30 ASHLAND (SAUNDERS) Ashland Care Center 1700 FURNAS STREET (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC GAY HARBERTS, PROVISIONAL ADM CARA NICHOLSON, Director of Nursing Medicare/Medicaid - 97 Total Lic - 97 c/o: ASHLAND CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA BEHAVIORAL NEEDS RESPIRATORY THERAPY ATKINSON (HOLT) Good Samaritan Society - Atkinson 409 NEELY STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY JESSICA EBY, ADMINISTRATOR LINDA PRICE, Director of Nursing Medicare/Medicaid - 61 Total Lic - 61

6 Page 4 of 48 AUBURN (NEMAHA) Good Samaritan Society - Auburn 1322 U STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY JEFFREY HARVEY, ADMINISTRATOR AMANDA HARRIFELD, Director of Nursing Medicare/Medicaid Total Lic AURORA (HAMILTON) Hamilton Manor TH STREET (402) FAX: (402) HAMILTON COUNTY HOME FOR THE AGED MARGARET WILLIAMS, ADMINISTRATOR DEBRA MCKINNON, Director of Nursing Medicare/Medicaid - 60 Total Lic - 60 AURORA (HAMILTON) Memorial Community Care 1423 SEVENTH STREET (402) FAX: (402) MEMORIAL COMMUNITY HEALTH, INC. DIANE KELLER, ADMINISTRATOR JULIE PICEK, Director of Nursing NF LTCH 28E191 LTCH001 Medicaid - 48 Medicare/ Total Lic - 48 BASSETT (ROCK) Rock County Hospital LTC 100 EAST SOUTH STREET (402) FAX: (402) ROCK COUNTY STACEY KNOX, ADMINISTRATOR BRITTANY DEVALL-HEYDEN, Director of Nursing NF LTCH 28E278 LTCH002 Medicaid - 30 Medicare/ Total Lic - 30 BATTLE CREEK (MADISON) Community Pride Care Center 901 SOUTH 4TH STREET (402) FAX: (402) CITY OF BATTLE CREEK STEVEN FREESE, ADMINISTRATOR NATALITE YONAMINE, Director of Nursing Medicare/Medicaid - 47 Total Lic - 47

7 Page 5 of 48 BAYARD (MORRILL) Chimney Rock Villa P O BOX A, 106 EAST 13TH STREET (308) FAX: (308) CITY OF BAYARD PEGGY RATZLAFF, PROVISIONAL ADM CYNTHIA CRAMER, Director of Nursing Medicare/Medicaid - 49 Total Lic - 49 BEATRICE (GAGE) Beatrice Health and Rehabilitaion 1800 IRVING STREET (402) FAX: (402) MONROE HEALTHCARE, INC SPENCER MORRIS, ADMINISTRATOR LORI PORTER, Director of Nursing Medicare/Medicaid - 87 Total Lic - 87 BEATRICE (GAGE) Good Samaritan Society - Beatrice 401 S 22ND STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CORRENE ADAMS, ADMINISTRATOR CERICE CORNELIUS, Director of Nursing NH0015 Medicare/Medicaid - 80 Total Lic - 80 BEAVER CITY (FURNAS) Beaver City Manor P O BOX 70, 905 FLOYD STREET (308) FAX: (308) CITY OF BEAVER CITY MEGAN MAPES, PROVISIONAL ADM NICOLE BOSE, Director of Nursing Medicare/Medicaid - 28 Total Lic - 28 BEEMER (CUMING) Colonial Haven 424 HARRISON (402) FAX: (402) VILLAGE OF BEEMER LAUREN LIERMAN, ADMINISTRATOR SHAYLA RISCH, Director of Nursing Medicare/Medicaid - 34 Total Lic - 34 RESPIRATORY THERAPY

8 Page 6 of 48 BELLEVUE (SARPY) Eastern Nebraska Veterans Home SOUTH 40TH STREET (402) FAX: (402) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM TROY SCHULZ, ADMINISTRATOR TARYN STRUTHERS, Director of Nursing SNF-LIC NH0005 Medicare/ Total Lic BELLEVUE (SARPY) S/NF DP Hillcrest Health & Rehab HILLCREST DRIVE (402) FAX: (402) RED OAK HEALTH SERVICES, INC. KEVIN SAUBERZWEIG, ADMINISTRATOR TAMMIE KNIGHT, Director of Nursing 1902 HARLAN DRIVE, SUITE A, BELLEVUE NE Medicare - 91 Medicare/Medicaid - 23 Total Lic BENKELMAN (DUNDY) Sarah Ann Hester Memorial Home P O BOX 646, 407 DAKOTA STREET (308) FAX: (308) SARAH ANN HESTER MEMORIAL HOME JANICE EDWARDS, ADMINISTRATOR KELLIE SIMEON, Director of Nursing Medicare/Medicaid - 56 Total Lic - 56 BERTRAND (PHELPS) Bertrand Nursing Home PO BOX 97, 100 MINOR AVENUE (308) FAX: (308) VILLAGE OF BERTRAND AMY GRUBE, ADMINISTRATOR TERESA STADLER, Director of Nursing Medicare/Medicaid - 26 Total Lic - 26 BLAIR (WASHINGTON) Crowell Memorial Home 245 SOUTH 22ND STREET (402) FAX: (402) CROWELL MEMORIAL HOME WILLIAM WILLIARD, ADMINISTRATOR PRUDENCE CEMER, Director of Nursing Medicare/Medicaid - 88 Total Lic - 88

9 Page 7 of 48 BLAIR (WASHINGTON) Good Shepherd Lutheran Home 2242 WRIGHT STREET (402) FAX: (402) GOOD SHEPHERD LUTHERAN COMMUNITY AMIE CLAUSEN, ADMINISTRATOR NANCY PEDERSEN, Director of Nursing Medicare/Medicaid - 84 Total Lic - 84 BLOOMFIELD (KNOX) Good Samaritan Society - Bloomfield P O BOX 307, 300 NORTH SECOND ST (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY GAIL BLOCKER, ADMINISTRATOR PATRICIA DOERING, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70 PEDIATRIC BLUE HILL (WEBSTER) Blue Hill Care Center 414 NORTH WILSON (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC SHERRILL ACTON, ADMINISTRATOR KELLY BOOM, Director of Nursing Medicare/Medicaid - 62 Total Lic - 62 c/o: BLUE HILL CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA BRIDGEPORT (MORRILL) Skyview at Bridgeport 505 O STREET (308) FAX: (308) CITY OF BRIDGEPORT VIRGINIA CLARKE, ADMINISTRATOR JAMA OENNING, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 BROKEN BOW (CUSTER) Golden LivingCenter - Broken Bow 224 EAST SOUTH E STREET (308) FAX: (308) GGNSC BROKEN BOW LLC KELLY ALDERMAN, ADMINISTRATOR PAMELA TAYLOR, Director of Nursing Medicare/Medicaid - 79 Total Lic - 79

10 Page 8 of 48 BROKEN BOW (CUSTER) Jennie M Melham Medical Center LTC P O BOX 250, 145 MEMORIAL DRIVE (308) FAX: (308) JENNIE M. MELHAM MEMORIAL MEDICAL CENTER, INC. MICHAEL STECKLER, ADMINISTRATOR BEVERLY TREW, Director of Nursing NF LTCH 28A056 LTCH004 Medicaid - 50 Medicare/ Total Lic - 50 BURWELL (GARFIELD) Community Memorial Health Center LTC P O BOX 340, 295 NORTH 8TH STREET (308) FAX: (308) COMMUNITY MEMORIAL HOSPITAL, INC. TIMOTHY GROSHANS, ADMINISTRATOR JENNIFER LARSON, Director of Nursing LTCH LTCH005 Medicare/Medicaid - 55 Total Lic - 55 BUTTE (BOYD) Butte Senior Living 210 BROADWAY (402) FAX: (402) TEALWOOD CARE CENTERS SUE CONNOT, ADMINISTRATOR DESSI BOETTCHER, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 CALLAWAY (CUSTER) Callaway Good Life Center, Inc PO BOX 250, 600 WEST KIMBALL STREET (308) FAX: (308) CALLAWAY GOOD LIFE CENTER, INC VICKY HENDRICKS, ADMINISTRATOR JANICE BARNES, Director of Nursing c/o: CALLAWAY GOOD LIFE CENTER, INC PO BOX 250, CALLAWAY NE Medicare/Medicaid - 35 Total Lic - 35 CAMBRIDGE (FURNAS) Cambridge Manor P O BOX 488, WEST HWY 6 & 34 (308) FAX: (308) TRI VALLEY HEALTH SYSTEM JOYCE DEAVER, ADMINISTRATOR BARBARA HELBERG, Director of Nursing NF 28E Medicaid - 34 Medicare/ Total Lic - 34

11 Page 9 of 48 CENTRAL CITY (MERRICK) Central City Care Center 2720 SOUTH 17TH AVENUE (308) FAX: (308) FIVE STAR QUALITY CARE NE, INC KATHERINE KLINGSPORN, ADMINISTRATOR STEVEN ROY, Director of Nursing Medicare/Medicaid - 63 Total Lic - 64 c/o: CENTRA CITY CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA BEHAVIORAL NEEDS CENTRAL CITY (MERRICK) Litzenberg Memorial County Hospital TH STREET (308) FAX: (308) LITZENBERG MEMORIAL MERRICK COUNTY JULIE MURRAY, ADMINISTRATOR LAURIE JOHNSON, Director of Nursing LTCH LTCH006 Medicare/Medicaid - 46 Total Lic - 46 CHADRON (DAWES) Crest View Healthcare Community 420 GORDON AVENUE (308) FAX: (308) CHADRON HEALTHCARE, LLC CATHY SNYDER, ADMINISTRATOR KELLI SCHERBARTH, Director of Nursing Medicare/Medicaid - 70 Total Lic - 70 CHAPPELL (DEUEL) Miller Memorial Care Center, LLC P O BOX 428, 589 VINCENT AVENUE (308) FAX: (308) MILLER MEMORIAL CARE CENTER, LLC AMBER DICKINSON, ADMINISTRATOR MARY HINNEGAN, Director of Nursing NF 28E Medicaid - 24 Medicare/ Total Lic - 24 CLARKSON (COLFAX) Golden LivingCenter - Clarkson 212 SUNRISE DRIVE (402) FAX: (402) COMMERCIAL MANAGEMENT, INC. KIM DVORAK, ADMINISTRATOR MEGAN NIEWOHNER, Director of Nursing Medicare/Medicaid - 51 Total Lic - 52

12 Page 10 of 48 COLERIDGE (CEDAR) Park View Haven Nursing Home 309 NORTH MADISON STREET (402) FAX: (402) VILLAGE TRUSTEES OF COLERIDGE SHERYL KALIN, ADMINISTRATOR KRISTINE KARNES-SNYDER, Director of Nursing Medicare/Medicaid - 34 Total Lic - 34 COLUMBUS (PLATTE) Brookestone Acres TH STREET (402) FAX: (402) COLUMBUS HEALTH CARE, INC TANYA BABEL, ADMINISTRATOR DAN SMITH, Director of Nursing NH0018 Medicare/Medicaid - 80 Total Lic - 80 COLUMBUS (PLATTE) Columbus Community Hospital LTC TH STREET (402) FAX: (402) COLUMBUS COMMUNITY HOSPITAL, INC. MICHAEL HANSEN, ADMINISTRATOR GINA OLSON, Director of Nursing SNF-LIC LTC LTCH007 Medicare/ Total Lic - 4 COLUMBUS (PLATTE) Golden LivingCenter - Columbus P O BOX 625, TH AVENUE (402) FAX: (402) GGNSC COLUMBUS LLC ROBERT SHECKLER, ADMINISTRATOR MELINDA MOLT, Director of Nursing Medicare/Medicaid Total Lic COLUMBUS (PLATTE) Morys Haven TH STREET (402) FAX: (402) FIVE STAR QUALITY CARE NE, INC TERRI GROTELUSCHEN, ADMINISTRATOR KRISTIN RASMUSSEN, Director of Nursing Medicare/Medicaid - 48 Total Lic - 48 c/o: MORYS HAVEN FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA 02458

13 Page 11 of 48 COZAD (DAWSON) Golden LivingCenter - Cozad 318 WEST 18TH STREET (308) FAX: (308) GGNSC COZAD LLC BARRY EMERSON, ADMINISTRATOR CAROLYN GRIESE, Director of Nursing Medicare/Medicaid - 67 Total Lic - 67 CRAWFORD (DAWES) Ponderosa Villa P O BOX 526, FIRST & PADDOCK STREET (308) FAX: (308) CITY OF CRAWFORD STEPHANIE HUFFMAN, ADMINISTRATOR TRACI DIDIER, Director of Nursing Medicare/Medicaid - 35 Total Lic - 35 CREIGHTON (KNOX) Avera Creighton Care Centre P O BOX 289, 1603 MAIN STREET (402) FAX: (402) AVERA SACRED HEART HEALTH SERVICES JENNIFER POPPEN, ADMINISTRATOR TANYA CURTIS, Director of Nursing LTCH LTCH008 Medicare/Medicaid - 47 Total Lic - 47 CRETE (SALINE) Premier Estates of Crete, LLC 830 EAST 1ST STREET (402) FAX: (402) PREMIER ESTATES OF CRETE, LLC DANIEL STACKIS, PROVISIONAL ADM MARLENE WALENTA, Director of Nursing Medicare/Medicaid Total Lic c/o: PREMIER ESTATES OF CRETE, LLC TRILLIUM HEALTHCARE CONSULTING, 5265 OFFICE PARK BLVD, SUITE 101, BRADENTON FL CRETE (SALINE) Tabitha Nursing Center at Crete P O BOX 9, 1540 GROVE STREET (402) FAX: (402) TABITHA INC. SHERRI DUE, ADMINISTRATOR MICHELLE HUNTER, Director of Nursing NH0003 c/o: TABITHA, INC. ATTENTION: CFO, 4720 RANDOLPH STREET, LINCOLN NE Medicare/Medicaid - 44 Total Lic - 44

14 Page 12 of 48 DAVID CITY (BUTLER) David Place 260 SOUTH 10TH STREET (402) FAX: (402) HERITAGE OF DAVID CITY, INC. BARBARA ALDRICH, ADMINISTRATOR TRUDY SVOBODA, Director of Nursing Medicare/Medicaid - 86 Total Lic - 86 DAVID CITY (BUTLER) St. Joseph's Villa, Inc. 927 SEVENTH STREET (402) FAX: (402) ST. JOSEPH'S VILLA, INC. SANDRA PALMER, ADMINISTRATOR RUTH HEULE, Director of Nursing Medicare/Medicaid - 58 Total Lic - 58 DESHLER (THAYER) Parkview Haven Nursing Home P O BOX 667, TH STREET (402) FAX: (402) CITY OF DESHLER MARY MILLER, ADMINISTRATOR JUDY KUJATH, Director of Nursing Medicare/Medicaid - 49 Total Lic - 49 DODGE (DODGE) Parkview Home, Inc 930 2ND STREET (402) FAX: (402) PARKVIEW HOME, INC. KELLEY SEITZ, ADMINISTRATOR CARA GUNTER, Director of Nursing Medicare/Medicaid - 62 Total Lic - 64 EDGAR (CLAY) Rose Brook Care Center 106 5TH STREET (402) FAX: (402) ROSE BROOK CARE CENTER, LLC BRAD HONL, PROVISIONAL ADM KARA EDWARDS, Director of Nursing c/o: ROSE BROOK CARE CENTER 190 S MAIN STREET, BOUNTIFUL UT Medicare/Medicaid - 47 Total Lic - 47

15 Page 13 of 48 ELKHORN (DOUGLAS) Brookestone Meadows Rehabilitation And Care Center 600 BROOKESTONE MEADOWS PLAZA (402) FAX: (402) BROOKESTONE MEADOWS, INC REVONNA WHITE, ADMINISTRATOR DAWN TRUCKENBROD, Director of Nursing S/NF DP NH0006 Medicare - 74 Medicare/Medicaid - 66 Total Lic c/o: BROOKESTONE MEADOWS C/O VETTER HOLDING INC, 5020 S 118TH ST, OMAHA NE ELKHORN (DOUGLAS) Life Care Center of Elkhorn HOPPER STREET (402) FAX: (402) CONSOLIDATED RESOURCES HEALTH CARE FUND I, L.P. PAUL MORRIS, ADMINISTRATOR PEGGY MART, Director of Nursing Medicare/Medicaid Total Lic ELWOOD (GOSPER) Elwood Care Center P O BOX 315, 607 SMITH AVENUE (308) FAX: (308) VILLAGE OF ELWOOD KATE REINERS, ADMINISTRATOR AMANDA KLEIN, Director of Nursing Medicare/Medicaid - 43 Total Lic - 47 EMERSON (DAKOTA) Heritage of Emerson, Inc. 607 NEBRASKA STREET (402) FAX: (402) HERITAGE OF EMERSON, INC. SHELLEE HUGGENBERGER, ADMINISTRATOR DANIEL SCHOCK, Director of Nursing Medicare/Medicaid - 38 Total Lic - 38 EXETER (FILLMORE) Exeter Care Center P O BOX 59, 425 SOUTH EMPIRE AVENUE (402) FAX: (402) EXETER CARE CENTER, LLC MIRIAM WALL, ADMINISTRATOR SHARON LOCKWOOD, Director of Nursing Medicare/Medicaid - 56 Total Lic - 56 c/o: EXETER CARE CENTER 500 NORTH MARKET PLACE DRIVE, SUITE 203, CENTERVILLE UT 84014

16 Page 14 of 48 FAIRBURY (JEFFERSON) Gardenside LTC-JCHC P O BOX 277, 2200 NORTH H STREET (402) FAX: (402) JEFFERSON COMMUNITY HEALTH CENTER, INC. DEBRA SUTTON, ADMINISTRATOR LINDA COLLINS, Director of Nursing LTCH LTCH010 Medicare/Medicaid - 39 Total Lic - 40 FAIRBURY (JEFFERSON) Heritage Care Center P O BOX 667, TH STREET (402) FAX: (402) HERITAGE OF FAIRBURY/ST. EDWARD, INC. BETH BLOCK, ADMINISTRATOR MARGARET SPILKER, Director of Nursing Medicare/Medicaid Total Lic FAIRMONT (FILLMORE) Fairview Manor 255 F STREET (402) FAX: (402) VILLAGE OF FAIRMONT TAMARA SCHEIL, ADMINISTRATOR JOAN RIEL, Director of Nursing Medicare/Medicaid - 40 Total Lic - 40 FALLS CITY (RICHARDSON) Falls City Healthcare Community 2800 TOWLE STREET (402) FAX: (402) FALLS CITY HEALTHCARE, LLC VALERIE BUCKMINSTER, ADMINISTRATOR CLAUDIA GEIER, Director of Nursing Medicare/Medicaid Total Lic FALLS CITY (RICHARDSON) Falls City Nursing and Rehabilitation Center 1720 BURTON DRIVE (402) FAX: (402) STANTON LAKE HEALTHCARE, INC DAVID YOUNG, ADMINISTRATOR MICHELE FREDERICK, Director of Nursing Medicare/Medicaid - 63 Total Lic - 65

17 Page 15 of 48 FRANKLIN (FRANKLIN) Golden LivingCenter - Franklin 1006 M STREET (308) FAX: (308) GGNSC FRANKLIN III LLC CANDACE GIBSON, ADMINISTRATOR MARY GOESSLING, Director of Nursing Medicare/Medicaid - 42 Total Lic - 42 FREMONT (DODGE) Dunklau Gardens 450 EAST 23RD STREET (402) FAX: (402) FREMONT HEALTH RACHEL REIMAN, ADMINISTRATOR JOANN STROUF, Director of Nursing S/NF DP LTC LTCH011 Medicare - 16 Medicare/Medicaid - 96 Total Lic FREMONT (DODGE) Nye Legacy Health & Rehabilitation Center 3210 N CLARKSON (402) FAX: (402) FREMONT CARE CENTER, INC. KRISTIN HARRIS, ADMINISTRATOR DEBRA FILTER, Director of Nursing S/NF DP NH0008 Medicare - 34 Medicare/Medicaid - 66 Total Lic c/o: NYE LEGACY HEALTH & REHABILITATION CENTER C/O FREMONT CARE CENTER INC, 2230 N SOMERS, FREMONT NE RESPIRATORY THERAPY FREMONT (DODGE) Nye Pointe Health & Rehab Ctr 2700 LAVERNA STREET (402) FAX: (402) FREMONT CARE CENTER, INC. MARK HOYLE, ADMINISTRATOR LISA FERRILL, Director of Nursing Medicare/Medicaid - 43 Total Lic - 43 FREMONT (DODGE) Premier Estates of Fremont, LLC 2550 NORTH NYE AVENUE (402) FAX: (402) PREMIER ESTATES OF FREMONT, LLC MARIA GETZSCHMAN, ADMINISTRATOR SUSAN DEVEREAUX, Director of Nursing Medicare/Medicaid Total Lic c/o: PREMIER ESTATES OF FREMONT, LLC TRILLIUM HEALTHCARE CONSULTING, 5265 OFFICE PARK BLVD, SUITE 101, BRADENTON FL 34203

18 Page 16 of 48 FRIEND (SALINE) Warren Memorial Hospital LTC 905 SECOND STREET (402) FAX: (402) CITY OF FRIEND CHRISTOPHER BJORNBERG, ADMINISTRATOR KIM PIETZYK, Director of Nursing NF 28E Medicaid - 51 Medicare/ Total Lic - 51 FULLERTON (NANCE) Golden LivingCenter - Fullerton P O BOX 648, 202 NORTH ESTHER (308) FAX: (308) GGNSC FULLERTON LLC MELISSA VANDEWALLE, ADMINISTRATOR BETH BOWMAN, Director of Nursing Medicare/Medicaid - 75 Total Lic - 75 BEHAVIORAL NEEDS GENEVA (FILLMORE) Heritage Crossings 501 NORTH 13TH STREET (402) FAX: (402) MANOR OF GENEVA, INC. STEPHANIE WITT, ADMINISTRATOR LAURA LEA, Director of Nursing Medicare/Medicaid - 68 Total Lic - 68 GENOA (NANCE) Genoa Community Hospital/LTC P O BOX 310, 606/706 EWING AVENUE (402) FAX: (402) CITY OF GENOA MICHAEL HARRIS, PROVISIONAL ADM FAITH WEAVER, Director of Nursing NF 28E Medicaid - 39 Medicare/ Total Lic - 39 GERING (SCOTTS BLUFF) The Lodge at Heritage Estates 2325 LODGE DRIVE (308) FAX: (308) HERITAGE OF GERING, INC. KENNETH BRUCKNER, ADMINISTRATOR KRISTIN FOX, Director of Nursing NH0002 Medicare/Medicaid Total Lic - 102

19 Page 17 of 48 GORDON (SHERIDAN) Gordon Countryside Care 500 EAST 10TH STREET (308) FAX: (308) GORDON MEMORIAL HOSPITAL DISTRICT JULIE SCHNELL, ADMINISTRATOR JENNIFER COMBS, Director of Nursing NF 28E Medicaid - 32 Medicare/ Total Lic - 32 GOTHENBURG (DAWSON) Hilltop Estates P O BOX 429, 2520 AVENUE M (308) FAX: (308) K. C. HEALTH CARE ENTERPRISES, INC. SCOTT BAHE, ADMINISTRATOR SERINA SLADKY, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64 GRAND ISLAND (HALL) CHI Health St. Francis 2116 WEST FAIDLEY AVENUE (308) FAX: (308) CATHOLIC HEALTH INITIATIVES DAN MCELLIGOTT, ADMINISTRATOR LTCH LTCH014 Medicare/Medicaid - 36 Total Lic - 36 GRAND ISLAND (HALL) Golden LivingCenter - Grand Island Lakeview 1405 WEST HWY 34 (308) FAX: (308) GGNSC GRAND ISLAND LAKEVIEW LLC SALLY BERNEY, ADMINISTRATOR JACKI CONNERY, Director of Nursing Medicare/Medicaid - 95 Total Lic - 95 GRAND ISLAND (HALL) Golden LivingCenter - Grand Island Park Place 610 NORTH DARR AVENUE (308) FAX: (308) GGNSC GRAND ISLAND PARK PLACE LLC LESLIE FENNELL, ADMINISTRATOR AMBER ROSNO, Director of Nursing Medicare/Medicaid - 85 Total Lic - 85

20 Page 18 of 48 GRAND ISLAND (HALL) Good Samaritan Society - Grand Island Village 4061 TIMBERLINE STREET & 4055 TIMBERLINE STREET (308) FAX: (308) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY CHERI THEESEN, ADMINISTRATOR CHERYL CHRISTENSON, Director of Nursing NH0010 Medicare/Medicaid - 61 Total Lic - 61 c/o: GOOD SAMARITAN SOCIETY - GRAND ISLAND VILLAGE ATTN: ADMINISTRATOR, 4075 TIMBERLINE STREET, GRAND ISLAND NE GRAND ISLAND (HALL) Grand Island Veterans Home 2300 WEST CAPITAL AVE (308) FAX: (308) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM ALEXANDER WILLFORD, ADMINISTRATOR DANIELLE DEAVER, Director of Nursing SNF-LIC Medicare/ Total Lic GRAND ISLAND (HALL) Tiffany Square Care Center 3119 WEST FAIDLEY AVENUE (308) FAX: (308) GRAND ISLAND HEALTH CARE, INC. DUSTIN FREY, ADMINISTRATOR KEVIN VOGT, Director of Nursing Medicare/Medicaid Total Lic GRAND ISLAND (HALL) Wedgewood Care Center 800 STOEGER DRIVE (308) FAX: (308) FIVE STAR QUALITY CARE-NE, LLC CHERYL SCHULZ, ADMINISTRATOR ANGELA CORNELIUS, Director of Nursing Medicare/Medicaid - 76 Total Lic - 76 c/o: WEDGEWOOD CARE CENTER FIVE STAR QUALITY CARE ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA 02458

21 Page 19 of 48 GRANT (PERKINS) Golden Ours Convalescent Home 902 CENTRAL AVENUE (308) FAX: (308) PERKINS COUNTY HOSPITAL DISTRICT MARGARET ROGERS, ADMINISTRATOR MICHELLE WOJCZYNSKI, Director of Nursing NF LTCH 28E199 LTCH015 Medicaid - 50 Medicare/ Total Lic - 50 GREELEY (GREELEY) Greeley Care Home 201 E O'CONNOR AVENUE (308) FAX: (308) VILLAGE OF GREELEY LORA MOUSEL, ADMINISTRATOR PAUL SULLIVAN, Director of Nursing Medicare/Medicaid - 26 Total Lic - 26 GRETNA (SARPY) Gretna Care Center 700 HIGHWAY 6 (402) FAX: (402) FIVE STAR QUALITY CARE-NE, LLC WILLIAM GERKEN, ADMINISTRATOR ELIZABETH BUCKINGHAM, Director of Nursing Medicare/Medicaid - 63 Total Lic - 63 c/o: GRETNA CARE CENTER FIVE STAR QUALITY CARE, ATTN: LICENSING, 400 CENTRE STREET, NEWTON MA HARTINGTON (CEDAR) Golden LivingCenter - Hartington P O BOX 107, 401 DARLENE STREET (402) FAX: (402) GGNSC HARTINGTON LLC LEIGH BLOOMQUIST, ADMINISTRATOR STEPHANIE MORTEN, Director of Nursing Medicare/Medicaid - 47 Total Lic - 47 HARVARD (CLAY) Harvard Rest Haven 400 EAST 7TH STREET (402) FAX: (402) CITY OF HARVARD RUTH SANDS-JERKE, ADMINISTRATOR CHRISTINA BUCKHALTER, Director of Nursing Medicare/Medicaid - 37 Total Lic - 37

22 Page 20 of 48 HASTINGS (ADAMS) Good Samaritan Society - Hastings Village P O BOX 2149, 926 EAST E STREET (402) FAX: (402) EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY DORIN VAIPAN, ADMINISTRATOR JERI WICHMAN, Director of Nursing Medicare/Medicaid Total Lic HASTINGS (ADAMS) Mary Lanning Memorial Healthcare Long Term Care 715 NORTH ST. JOSEPH AVENUE (402) FAX: (402) MARY LANNING HEALTHCARE MARK CALLAHAN, ADMINISTRATOR LTCH016 Medicare/Medicaid - 9 Total Lic - 9 HAY SPRINGS (SHERIDAN) Pioneer Manor Nursing Home P O BOX 310, 318 N 3RD STREET (308) FAX: (308) CITY OF HAY SPRINGS KRYSTYN TURMAN, PROVISIONAL ADM BRENDA JOHNSON, Director of Nursing Medicare/Medicaid - 57 Total Lic - 57 HEBRON (THAYER) Blue Valley Lutheran Care Home P O BOX 166, 755 SOUTH 3RD STREET (402) FAX: (402) BLUE VALLEY LUTHERAN HOMES SOCIETY, INC. KATHY RETZLAFF, ADMINISTRATOR CAROL MUEHLING, Director of Nursing NF 28E Medicaid - 64 Medicare/ Total Lic - 64 HEBRON (THAYER) Blue Valley Lutheran Nursing Home P O BOX 166, 220 PARK AVENUE (402) FAX: (402) BLUE VALLEY LUTHERAN HOMES SOCIETY, INC. ALAN JARECKI, PROVISIONAL ADM KERREY MILLER, Director of Nursing Medicare/Medicaid - 64 Total Lic - 64

23 Page 21 of 48 HEMINGFORD (BOX BUTTE) Hemingford Community Care Center P O BOX 307, 605 DONALD AVENUE (308) FAX: (308) HEMINGFORD COMMUNITY CARE CENTER KRISTY BOLEK, ADMINISTRATOR ANGELA MCKEE, Director of Nursing Medicaid - 33 Medicare/ Total Lic - 33 BEHAVIORAL NEEDS HENDERSON (YORK) Henderson Care Center 1621 FRONT STREET (402) FAX: (402) HENDERSON HEALTH CARE SERVICES, INC CHERYL BROWN, ADMINISTRATOR MICHELE GEORGE, Director of Nursing NF LTCH 28E173 LTCH017 Medicaid - 42 Medicare/ Total Lic - 42 HOLDREGE (PHELPS) Christian Homes Health Care Center 1923 WEST 4TH AVENUE (308) FAX: (308) CHRISTIAN HOMES, INC. DON BAKKE, ADMINISTRATOR CINDY PETERSON, Director of Nursing Medicare/Medicaid - 86 Total Lic - 86 BEHAVIORAL NEEDS HOLDREGE (PHELPS) Holdrege Memorial Homes, Inc TH AVENUE (308) FAX: (308) HOLDREGE MEMORIAL HOMES KEVIN MORIARTY, ADMINISTRATOR LINDA CARPENTER, Director of Nursing Medicare/Medicaid - 94 Total Lic - 94 HOOPER (DODGE) Hooper Care Center 400 EAST BIRCHWOOD DRIVE (402) FAX: (402) HOOPER HEALTH CARE, INC. DIANE VILLWOK, ADMINISTRATOR MICHELE WENDT, Director of Nursing Medicare/Medicaid - 48 Total Lic - 48

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