STATE OF NEBRASKA ROSTER HOSPITALS. General Acute Hospitals Critical Access Hospitals Rehabilitation Hospitals Psychiatric Hospitals

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1 STATE OF NEBRASKA ROSTER HOSPITALS General Acute Hospitals Critical Access Hospitals Rehabilitation Hospitals Psychiatric Hospitals Department of Health and Human Division of Public Health, Licensure Unit 301 Centennial Mall South-Third Floor PO Box Lincoln, NE Hospital Licenses Expire December 31, of each year

2 NEBRASKA HOSPITALS Number of Licensed Facilities Number of Licensed 29 4, ,281 HOSP-CHD HOSP-LT PSY PSYCH REH HOSP 1 96 LEGEND Total: HOSP-CHD HOSP-LT LTCH/LIC PSY PSYCH REH HOSP AOA CARF General Acute Hospital Critical Access Hospital Children's Hospital Long Term Care Hospital Long Term Care Hospital - Licensed Only Psychiatric - Licensed Only Psychiatric Hospital Rehabilitation Hospital The Joint Commission American Osteopathic Association Commission on of Rehabilitation Facilities Please contact the Licensure Unit or the provider to determine current Medicare/Medicaid status Updated: 07/02/2015

3 Page 2 of 24 AINSWORTH (BROWN) Brown County Hospital 945 EAST ZERO ST (402) FAX: (402) BROWN COUNTY SHANNON SORENSEN, ADMINISTRATOR Medicare/Medicaid - 23 Total Lic - 23 ALBION (BOONE) Boone County Health Center P O BOX 151, 723 WEST FAIRVIEW ST (402) FAX: (402) BOONE COUNTY VICTOR LEE, ADMINISTRATOR Total Lic - 25 BRANCH/EXTENSION/OFFSITE: BOONE COUNTY HEALTH CENTER MENTAL HEALTH SERVICES W FAIRVIEW ST, RM #1, ALBION BRANCH/EXTENSION/OFFSITE: ELGIN VETERANS MEDICAL CLINIC OUTPATIENT DEPT NORTH 2ND ST, ELGIN BRANCH/EXTENSION/OFFSITE: NEWMAN GROVE MEDICAL CLINIC OUTPATIENT DEPT N 1ST ST, NEWMAN GROVE ALLIANCE (BOX BUTTE) Box Butte General Hospital P O BOX 810, 2101 BOX BUTTE AVE (308) FAX: (308) BOX BUTTE COUNTY DANIEL GRIESS, ADMINISTRATOR Total Lic - 25 BRANCH/EXTENSION/OFFSITE: ALLIANCE CLINIC BOX BUTTE AVE, ALLIANCE BRANCH/EXTENSION/OFFSITE: MEDICAL ARTS PLAZA BOX BUTTE AVE, ALLIANCE ALMA (HARLAN) Harlan County Health System P O BOX 836, 717 NORTH BROWN ST (308) FAX: (308) HARLAN COUNTY HEALTH SYSTEM BOARD OF TRUSTEES MANUELA WOLF, ADMINISTRATOR Medicare/Medicaid - 19 Total Lic - 19 ATKINSON (HOLT) West Holt Memorial Hospital 406 W NEELY ST (402) FAX: (402) WEST HOLT MEMORIAL HOSPITAL, INC. TOM HOOVER, INTERIM ADMINIS Medicare/Medicaid - 17 Total Lic - 17

4 Page 3 of 24 AUBURN (NEMAHA) Nemaha County Hospital TH ST (402) FAX: (402) NEMAHA COUNTY HOSPITAL MARTIN FATTIG, ADMINISTRATOR DNV Medicare/Medicaid - 16 Total Lic - 16 AURORA (HAMILTON) Memorial Hospital 1423 SEVENTH ST (402) FAX: (402) MEMORIAL COMMUNITY HEALTH, INC. DIANE KELLER, ADMINISTRATOR Medicare/Medicaid - 14 Total Lic - 14 BASSETT (ROCK) Rock County Hospital 102 EAST SOUTH STREET (402) FAX: (402) ROCK COUNTY STACEY KNOX, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 24 BEATRICE (GAGE) Beatrice Community Hospital & Health Center, Inc H P O BOX 278, 4800 HOSPITAL PARKWAY (402) FAX: (402) BEATRICE COMMUNITY HOSPITAL & HEALTH CENTER, INC. THOMAS SOMMERS, ADMINISTRATOR Total Lic - 25 BELLEVUE (SARPY) Bellevue Medical Center DBA Nebraska Medicine - B 2500 BELLEVUE MEDICAL CENTER DR (402) FAX: (402) BELLEVUE MEDICAL CENTER, LLC DEB ISTAS, ADMINISTRATOR H Medicare/Medicaid - 55 Total Lic - 55

5 Page 4 of 24 BELLEVUE (SARPY) Madonna Rehabilitation Specialty Hospital 2500 BELLEVUE MEDICAL CENTER DRIVE, 4TH FLOOR (402) FAX: (402) MADONNA REHABILITATION SYSTEMS PAUL DONGILLI, JR, ADMINISTRATOR H Medicare/Medicaid - 32 Total Lic - 32 BENKELMAN (DUNDY) Dundy County Hospital P O BOX 626, 1313 NORTH CHEYENNE ST (308) FAX: (308) DUNDY COUNTY RITA JONES, ADMINISTRATOR Medicare/Medicaid - 14 Total Lic - 14 BLAIR (WASHINGTON) Memorial Community Hospital Corporation 810 NORTH 22ND ST (402) FAX: (402) MEMORIAL COMMUNITY HOSPITAL, INC ROBERT COPPLE, ADMINISTRATOR Medicare/Medicaid - 21 Total Lic - 21 BOYS TOWN (DOUGLAS) Boys Town National Research Hospital - West BOYS TOWN HOSPITAL RD (402) FAX: (402) FATHER FLANAGAN'S BOYS' HOME JOHN ARCH, ADMINISTRATOR HOSP-CHD H Medicare/Medicaid - 36 Total Lic - 36 % BOYS TOWN NATIONAL RESEARCH HOSPITAL, 555 NORTH 30TH STREET, OMAHA, NE BRIDGEPORT (MORRILL) Morrill County Community Hospital 1313 S STREET (308) FAX: (308) MORRILL COUNTY COMMUNITY HOSPITAL ROBIN STUART, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 20 BRANCH/EXTENSION/OFFSITE: MORRILL COUNTY COMMUNITY HEALTH CLINIC R ST, BRIDGEPORT

6 Page 5 of 24 BROKEN BOW (CUSTER) Jennie M Melham Memorial Medical Center MEMORIAL DRIVE (308) FAX: (308) JENNIE M MELHAM MEMORIAL MEDICAL CENTER, INC. MICHAEL STECKLER, ADMINISTRATOR Medicare/Medicaid - 23 Total Lic - 23 CALLAWAY (CUSTER) Callaway District Hospital P O BOX 100, 211 E KIMBALL ST (308) FAX: (308) CALLAWAY HOSPITAL DISTRICT MARVIN NETH, ADMINISTRATOR Medicare/Medicaid - 12 Total Lic - 12 CAMBRIDGE (FURNAS) Tri Valley Health System 1305 WEST HIGHWAY 6/34 (308) FAX: (308) CAMBRIDGE MEMORIAL HOSPITAL, INC. DEBORAH HERZBERG, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 20 BRANCH/EXTENSION/OFFSITE: TRI-VALLEY PHYSICAL THERAPY-ARAPAHOE PINE ST, ARAPAHOE CENTRAL CITY (MERRICK) Litzenberg Memorial County Hospital TH ST (308) FAX: (308) LITZENBERG MEMORIAL MERRICK COUNTY JULIE MURRAY, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 20 CHADRON (DAWES) Chadron Community Hospital & Health 825 CENTENNIAL DRIVE (308) FAX: (308) CHADRON COMMUNITY HOSPITAL, INC. HAROLD KRUEGER JR, ADMINISTRATOR H Total Lic - 25

7 Page 6 of 24 COLUMBUS (PLATTE) Columbus Community Hospital TH ST (402) FAX: (402) COLUMBUS COMMUNITY HOSPITAL, INC. MICHAEL HANSEN, ADMINISTRATOR Medicare/Medicaid - 47 Total Lic - 47 %, P O BOX 1800, COLUMBUS, NE BRANCH/EXTENSION/OFFSITE: COLUMBUS COMMUNITY HOSPITAL WIGGLES & GIGGLES THER TH ST, COLUMBUS BRANCH/EXTENSION/OFFSITE: COLUMBUS COMMUNITY HOSPITAL PREMIER P T - US 30 CENTER BLDG, RD ST, STE 15, COL BRANCH/EXTENSION/OFFSITE: COLUMBUS COMMUNITY HOSPITAL SLEEP LAB TH ST, STE 100, COLUMBUS BRANCH/EXTENSION/OFFSITE: COLUMBUS COMMUNITY HOSPITAL OCCUPATIONAL HEALTH TH ST, STE 300, COLUMBUS BRANCH/EXTENSION/OFFSITE: COLUMBUS COMMUNITY HOSPITAL LABORATORY TH ST, STE 168, COLUMBUS BRANCH/EXTENSION/OFFSITE: COLUMBUS COMMUNITY HOSPITAL DIABETES & HEALTH EDUC TH ST, STE 210, CCH ROOM BRANCH/EXTENSION/OFFSITE: COLUMBUS COMMUNITY HOSPITAL W.O.C. HEALTH CENTER TH ST, STE 210, ROOMS 1H, 2H COZAD (DAWSON) Cozad Community Hospital P O BOX 108, 300 EAST 12TH ST (308) FAX: (308) COZAD HOSPITAL DISTRICT #2 LYLE DAVIS, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 20 BRANCH/EXTENSION/OFFSITE: COZAD COMMUNITY PHYSICAL THERAPY EAST 12TH ST, COZAD CREIGHTON (KNOX) Avera Creighton Hospital P O BOX 186, 1503 MAIN ST (402) FAX: (402) AVERA SACRED HEART HEALTH SERVICES JENNIFER POPPEN, CEO Medicare/Medicaid - 23 Total Lic - 23 BRANCH/EXTENSION/OFFSITE: AVERA MEDICAL GROUP CREIGHTON MAIN ST, CREIGHTON CRETE (SALINE) Crete Area Medical Center P O BOX 220, 2910 BETTEN DR (402) FAX: (402) CRETE AREA MEDICAL CENTER WILLIAM WELCH, INTERIM ADMINIS Medicare/Medicaid - 24 Total Lic - 24 DAVID CITY (BUTLER) Butler County Health Care Center 372 SOUTH 9TH ST (402) FAX: (855) BUTLER COUNTY DON NAIBERK, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 20

8 Page 7 of 24 FAIRBURY (JEFFERSON) Jefferson Community Health Center, Inc. P O BOX 277, 2200 H ST (402) FAX: (402) JEFFERSON COMMUNITY HEALTH CENTER, INC. CHAD JURGENS, ADMINISTRATOR Medicare/Medicaid - 17 Total Lic - 17 FALLS CITY (RICHARDSON) Community Medical Center, Inc. P O BOX 399, 3307 BARADA ST (402) FAX: (402) COMMUNITY MEDICAL CENTER, INC. RYAN LARSEN, ADMINISTRATOR H Medicare/Medicaid - 24 Total Lic - 24 FRANKLIN (FRANKLIN) Franklin County Memorial Hospital P O BOX 315, 1406 Q ST (308) FAX: (308) FRANKLIN COUNTY LINDA BUSH, ADMINISTRATOR Medicare/Medicaid - 14 Total Lic - 14 FREMONT (DODGE) Fremont Health Medical Center 450 EAST 23RD ST (402) FAX: (402) DODGE COUNTY PATRICK BOOTH, ADMINISTRATOR Medicare/Medicaid - 90 Total Lic - 90 BRANCH/EXTENSION/OFFSITE: FREMONT HEALTH BEHAVIORAL MEDICINE E FREMONT MEDICAL PKWY, STE 300, FREMONT BRANCH/EXTENSION/OFFSITE: FREMONT HEALTH CARDIOVASCULAR CARE EAST 22ND ST, STE 101, FREMONT BRANCH/EXTENSION/OFFSITE: FREMONT HEALTH SURGERY CENTER EAST 29TH ST, FREMONT BRANCH/EXTENSION/OFFSITE: FREMONT HEALTH SPECIALTY CLINICS E FREMONT MEDICAL PARK DR, STE 200, FREMONT BRANCH/EXTENSION/OFFSITE: FREMONT HEALTH CENTER FOR WOUND HEALING EAST 29TH ST, FREMONT FRIEND (SALINE) Warren Memorial Hospital 905 SECOND ST (402) FAX: (402) CITY OF FRIEND CHRISTOPHER BJORNBERG, ADMINISTRATOR Medicare/Medicaid - 14 Total Lic - 14

9 Page 8 of 24 GENEVA (FILLMORE) Fillmore County Hospital P O BOX 193, 1900 F STREET (402) FAX: (402) FILLMORE COUNTY PAUL UTEMARK, ADMINISTRATOR H Medicare/Medicaid - 20 Total Lic - 20 GENOA (NANCE) Genoa Community Hospital/LTC P O BOX 310, 606/706 EWING AVE (402) FAX: (402) CITY OF GENOA AUSTIN GILLARD, ADMINISTRATOR Medicare/Medicaid - 19 Total Lic - 19 GORDON (SHERIDAN) Gordon Memorial Hospital District 300 EAST 8TH ST (308) FAX: (308) GORDON MEMORIAL HOSPITAL DISTRICT JULIE SCHNELL, ADMINISTRATOR Total Lic - 25 GOTHENBURG (DAWSON) Gothenburg Memorial Hospital TH ST (308) FAX: (308) GOTHENBURG MEMORIAL HOSPITAL DISTRICT MICHAEL BRANT, ADMINISTRATOR Medicare/Medicaid - 12 Total Lic - 12 GRAND ISLAND (HALL) CHI Health St. Francis 2620 WEST FAIDLEY AVE (308) FAX: (308) CATHOLIC HEALTH INITIATIVES DAN MC ELLIGOTT, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: ST FRANCIS MEDICAL CENTER CANCER TREATMENT CENTER W 2ND ST, STE 314, HASTINGS

10 Page 9 of 24 GRANT (PERKINS) Perkins County Health 900 LINCOLN AVE (308) FAX: (308) PERKINS COUNTY HOSPITAL DISTRICT JAMES LE BRUN, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 20 BRANCH/EXTENSION/OFFSITE: PERKINS CO HEALTH SERVICES TRAILER LINCOLN AVE, GRANT HASTINGS (ADAMS) Mary Lanning Healthcare 715 N ST JOSEPH AVE (402) FAX: (402) MARY LANNING HEALTHCARE ERIC BARBER, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: REHAB SERVICES - MARY LANNING HEALTHCARE NORTH KANSAS AVENUE, STE 100, HASTING BRANCH/EXTENSION/OFFSITE: MORRISON CANCER CENTER - MARY LANNING HEALTHCARE NORTH KANSAS AVENUE, HASTIN BRANCH/EXTENSION/OFFSITE: MARY LANNING HEALTHCARE HASTINGS IMAGING CENTER OSBORNE DR. WEST, STE 200, HA BRANCH/EXTENSION/OFFSITE: MARY LANNING HEALTHCARE MEDICAL PARK DIAGNOSTIC CT N KANSAS AVE, STE 106, HASTI BRANCH/EXTENSION/OFFSITE: MARY LANNING HEALTHCARE WOUND CENTER N KANSAS, STE 302, HASTINGS BRANCH/EXTENSION/OFFSITE: MARY LANNING HEALTHCARE DEPT OF REHAB & WELLNESS CIMARRON PLAZA, STE 170, HAS HEBRON (THAYER) Thayer County Health 120 PARK AVE (402) FAX: (402) THAYER COUNTY MICHAEL BURCHAM, SR., ADMINISTRATOR Medicare/Medicaid - 19 Total Lic - 19 HENDERSON (YORK) Henderson Health Care, Inc FRONT STREET (402) FAX: (402) HENDERSON HEALTH CARE SERVICES, INC CHERYL BROWN, ADMINISTRATOR Medicare/Medicaid - 13 Total Lic - 13

11 Page 10 of 24 HOLDREGE (PHELPS) Phelps Memorial Health Center 1215 TIBBALS ST Total Lic - 25 (308) FAX: (308) PHELPS MEMORIAL HEALTH CENTER MARK HARREL, ADMINISTRATOR BRANCH/EXTENSION/OFFSITE: PHELPS MEMORIAL THERAPY CENTER W 14TH AVE, STE 200, HOLDREGE BRANCH/EXTENSION/OFFSITE: PHELPS MEMORIAL HEALTH CENTER CARDIAC & PULMONARY WEST 14TH AVE, HOLDREGE BRANCH/EXTENSION/OFFSITE: PMHC SPECIALTY CLINIC W 14TH AVE, STE 300, HOLDREGE BRANCH/EXTENSION/OFFSITE: PMHC SPECIALTY CLINIC W 14TH AVE, STE 400, HOLDREGE IMPERIAL (CHASE) Chase County Community Hospital P O BOX 819, 600 W 12TH ST (308) FAX: (308) CHASE COUNTY STEPHEN LEWIS, CEO Medicare/Medicaid - 22 Total Lic - 22 KEARNEY (BUFFALO) CHI Health Good Samaritan P O BOX 1990, 10 EAST 31ST ST (308) FAX: (308) GOOD SAMARITAN HOSPITAL MICHAEL SCHNIEDERS, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: GOOD SAMARITAN HOSPITAL CANCER CENTER W 33RD ST, KEARNEY BRANCH/EXTENSION/OFFSITE: KEARNEY IMAGING CENTER CENTRAL AVE, STE 109, KEARNEY BRANCH/EXTENSION/OFFSITE: GOOD SAMARITAN HOSPITAL MEDICAL FITNESS & REHABILI CENTRAL AVE, LOWER LEVEL, K KEARNEY (BUFFALO) CHI Health Richard Young Behavioral Health P O BOX 1750, 1755 PRAIRIE VIEW PL (308) FAX: (308) GOOD SAMARITAN HOSPITAL MICHAEL SCHNIEDERS, ADMINISTRATOR PSYCH Medicare/Medicaid - 30 Total Lic - 61 KEARNEY (BUFFALO) Kearney Regional Medical Center ND AVENUE (308) FAX: (308) KEARNEY REGIONAL MEDICAL CENTER, LLC LARRY SPEICHER, ADMINISTRATOR H AOA Medicare/Medicaid - 44 Total Lic - 44 % JOE HLAVACEK, 200 W DOUGLAS, STE 950, WICHITA, KS 67202

12 Page 11 of 24 KIMBALL (KIMBALL) Kimball County Hospital 505 SOUTH BURG ST (308) FAX: (308) KIMBALL COUNTY KENNETH HUNTER, ADMINISTRATOR Medicare/Medicaid - 15 Total Lic - 15 BRANCH/EXTENSION/OFFSITE: KHS POTTER RURAL HEALTH CLINIC /2 SHERMAN, POTTER LEXINGTON (DAWSON) Lexington Regional Health Center P O BOX 980, 1201 NORTH ERIE ST Total Lic - 25 (308) FAX: (308) LEXINGTON REGIONAL HEALTH CENTER LESLIE MARSH, ADMINISTRATOR BRANCH/EXTENSION/OFFSITE: COMMUNITY HEALTH & FITNESS CENTER WEST 13TH ST, LEXINGTON BRANCH/EXTENSION/OFFSITE: LEXINGTON REGIONAL HEALTH CTR FAMILY MEDICINE SPEC N ERIE ST, LEXINGTON LINCOLN (LANCASTER) Bryan Medical Center 2300 SOUTH 16TH ST (402) FAX: (402) BRYAN MEDICAL CENTER JOHN WOODRICH, ADMINISTRATOR Medicare/Medicaid Total Lic % ATTN: ANGELA HERBERT, ORGANIZATIONAL QUALITY, BRYAN MEDICAL CENTER, 1600 SOUTH 48TH STREET LINCOLN, NE LINCOLN (LANCASTER) Bryan Medical Center 1600 SOUTH 48TH ST (402) FAX: (402) BRYAN MEDICAL CENTER JOHN WOODRICH, ADMINISTRATOR Medicare/Medicaid Total Lic % ATTN: ANGELA HERBERT, ORGANIZATIONAL QUALITY, BRYAN MEDICAL CENTER, 1600 SOUTH 48TH STREET LINCOLN, NE BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER COUNSELING CENTER SOUTH 17TH ST, STE 201, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER CARDIAC-VASCULAR OUTPATIENT S SOUTH 48TH ST, STE 301, LINC BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER COUNSELING CENTER SOUTH 17TH ST, STE 310, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER LABORATORY SOUTH 17TH ST, STE 100, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER OUTPATIENT BRYA SOUTH 48TH ST, 1ST FLOOR, LINC BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER OUTPATIENT RADIOLOGY PINE LAKE RD, SUITE 110, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER SOUTH 16TH ST, TOWER B STE 110, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER MRI SERVICES SOUTH 16TH ST, TOWER B STE 100, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER SOUTH 48TH ST, STE 600, RM 1, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER LINAC & CT/HDR SERVICES PINE LAKE RD, STE 111 LINAC RM 1 - HD BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER SOUTH 48TH ST, STE 400, VASCULAR SCAN RM, LINCOLN BRANCH/EXTENSION/OFFSITE: BRYAN MEDICAL CENTER THERAPY SERVICES S 27TH ST EXCLUDING STE 100 & FITNESS CT

13 Page 12 of 24 LINCOLN (LANCASTER) CHI Health Nebraska Heart 7500 SOUTH 91ST ST (402) FAX: (402) NEBRASKA HEART HOSPITAL PETER DIONISOPOULOS, ADMINISTRATOR H Medicare/Medicaid - 63 Total Lic - 63 BRANCH/EXTENSION/OFFSITE: NEBRASKA HEART HOSPITAL IMAGING CENTER SOUTH 91ST ST, STE 100, LINCOLN LINCOLN (LANCASTER) CHI Health St. Elizabeth 555 SOUTH 70TH ST (402) FAX: (402) CATHOLIC HEALTH INITIATIVES KIM MOORE, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: SAINT ELIZABETH OUTPATIENT CLINICS SOUTH 70TH ST, LINCOLN BRANCH/EXTENSION/OFFSITE: SAINT ELIZABETH WOUND CARE CENTER O ST, STE 200, LINCOLN LINCOLN (LANCASTER) PSYCH Lincoln Regional Center PO BOX FOLSOM & WEST PROSPECTOR (402) FAX: (402) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM WILLIAM GIBSON, ADMINISTRATOR Medicare/Medicaid - 68 Total Lic LINCOLN (LANCASTER) Lincoln Surgical Hospital 1710 SOUTH 70TH ST, SUITE 200 (402) FAX: (402) LINCOLN SURGERY CENTER, LLC ROBIN LINAFELTER, ADMINISTRATOR H Medicare/Medicaid - 21 Total Lic - 21 LINCOLN (LANCASTER) Madonna Rehabilitation Hospital 5401 SOUTH ST (402) FAX: (402) MADONNA REHABILITATION HOSPITAL MARSHA LOMMEL, ADMINISTRATOR REH HOSP CARF Medicare/Medicaid - 96 Total Lic - 96 % ATTN: PAUL DONGILLI, JR, PH.D., 5401 SOUTH STREET, LINCOLN, NE BRANCH/EXTENSION/OFFSITE: MADONNA REHAB HOSPITAL THERAPY PLUS NORTHWEST NORTHWEST 1ST ST, LINCOLN BRANCH/EXTENSION/OFFSITE: MADONNA REHAB HOSPITAL THERAPY PLUS PROACTIVE STEPHANIE LANE, LINCOLN

14 Page 13 of 24 LINCOLN (LANCASTER) Madonna Rehabilitation LTC Hospital 5401 SOUTH ST (402) FAX: (402) MADONNA REHABILITATION HOSPITAL SUSAN KLANECKY, ADMINISTRATOR HOSP-LT CARF Medicare - 96 Medicare/ Total Lic - 96 % ATTN: PAUL DONGILLI, JR, PH.D., 5401 SOUTH STREET, LINCOLN, NE LINCOLN (LANCASTER) Select Specialty Hospital - Lincoln 2300 SOUTH 16TH STREET - 7TH FLOOR (402) FAX: (402) SELECT SPECIALTY HOSPITAL - LINCOLN, INC. SCOTT BUTTERFIELD, ADMINISTRATOR HOSP-LT H Medicare/Medicaid - 24 Total Lic - 24 %, 4714 GETTYSBURG RD, ATTN: MELANIE NOTARIO MECHANICSBURG, PA LYNCH (BOYD) Niobrara Valley Hospital P O BOX 118, 401 SOUTH 5TH STREET (402) FAX: (402) NIOBRARA VALLEY HOSPITAL CORP KELLY KALKOWSKI, ADMINISTRATOR Medicare/Medicaid - 20 Total Lic - 20 BRANCH/EXTENSION/OFFSITE: NIOBRARA VALLEY HOSPITAL MEDICAL CLINIC WEST EVANS ST, SPENCER MCCOOK (RED WILLOW) Community Hospital P O BOX 1328, 1301 EAST H ST (308) FAX: (308) COMMUNITY HOSPITAL ASSOCIATION JAMES ULRICH, JR, ADMINISTRATOR Total Lic - 25 BRANCH/EXTENSION/OFFSITE: COMMUNITY HOSPITAL OUTPATIENT SERVICES EAST 1ST ST, TRENTON BRANCH/EXTENSION/OFFSITE: COMMUNITY HOSPITAL OUTPATIENT SERVICES EAST 6TH ST, CURTIS MINDEN (KEARNEY) Kearney County Health 727 EAST 1ST ST (308) FAX: (308) KEARNEY COUNTY FRED MEIS, ADMINISTRATOR Medicare/Medicaid - 10 Total Lic - 10

15 Page 14 of 24 NEBRASKA CITY (OTOE) CHI Health St Mary's 1301 GRUNDMAN BLVD (402) FAX: (402) ST. MARY'S COMMUNITY HOSPITAL DANIEL KELLY, ADMINISTRATOR H Medicare/Medicaid - 18 Total Lic - 18 NELIGH (ANTELOPE) Antelope Memorial Hospital P O BOX 229, 102 WEST 9TH ST (402) FAX: (402) ANTELOPE MEMORIAL HOSPITAL JACK GREEN, ADMINISTRATOR Total Lic - 25 NORFOLK (MADISON) Faith Reg Health /East Campus 1500 KOENIGSTEIN AVE (402) FAX: (402) FAITH REGIONAL HEALTH SERVICES MARK KLOSTERMAN, ADMINISTRATOR Medicare/Medicaid - 73 Total Lic - 73 NORFOLK (MADISON) Faith Reg Health /West Campus 2700 WEST NORFOLK AVE (402) FAX: (402) FAITH REGIONAL HEALTH SERVICES MARK KLOSTERMAN, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL SLEEP DISORDER CENTER NORTH 29TH ST, STE 203, NORFOLK BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL OUTPATIENT RADIOLOGY NORTH 27TH ST, STE 13, NORFOLK BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL HEALTH SERVICES OUTPATIENT CENTER WEST 2ND ST, TILDEN BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL CARDIAC & PULMONARY REHABILITATION NORTH 29TH ST, STE 202, NORFOL BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL CARSON CANCER CENTER NORTH 29TH ST, STE 101, NORFOLK BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL REHABILITATION THERAPIES PIERCE CLI N ST, RM 109, PIERCE BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL REHABILITATION THERAPIES STANTON CL KINGWOOD ST, TRAINING RM 124 BRANCH/EXTENSION/OFFSITE: FAITH REGIONAL ELECTROMYELOGRAPHY LAB N 27TH ST, STE 12, RM 3, NORFOLK NORFOLK (MADISON) PSY Norfolk Regional Center P O BOX 1209, 1700 NORTH VICTORY RD (402) FAX: (402) STATE OF NEBRASKA HEALTH & HUMAN SERVICES SYSTEM WILLIAM GIBSON, ADMINISTRATOR Medicare/ Total Lic - 150

16 Page 15 of 24 NORTH PLATTE (LINCOLN) Great Plains Health 601 WEST LEOTA ST (308) FAX: (308) NORTH PLATTE NE HOSPITAL CORPORATION MEL MCNEA, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: GREAT PLAINS HEALTH SPORTS & THERAPY CENTER SOUTH COTTONWOOD ST, NORTH PLA BRANCH/EXTENSION/OFFSITE: GREAT PLAINS HEALTH BEHAVIORAL HEALTH E FRANCIS ST, STE 8, NORTH PLATTE BRANCH/EXTENSION/OFFSITE: GREAT PLAINS HEALTH IMAGING CENTER SOUTH OAK, NORTH PLATTE BRANCH/EXTENSION/OFFSITE: GREAT PLAINS HEALTH SLEEP MEDICINE W LEOTA ST, STE 250, NORTH PLATTE O' NEILL (HOLT) Avera St. Anthony's Hospital 300 NORTH 2ND ST (402) FAX: (402) AVERA ST. ANTHONY'S HOSPITAL RONALD CORK, ADMINISTRATOR Total Lic - 25 OAKLAND (BURT) Oakland Mercy Hospital 601 EAST SECOND ST (402) FAX: (402) OAKLAND MERCY HOSPITAL JOHN WERNER, ADMINISTRATOR Medicare/Medicaid - 18 Total Lic - 18 OGALLALA (KEITH) Ogallala Community Hospital 2601 NORTH SPRUCE ST (308) FAX: (308) BANNER HEALTH SHARON LIND, CEO Medicare/Medicaid - 18 Total Lic - 18 % BANNER CERTIFICATION, CREDENTIALING & LICENSINS, P O BOX 16950, MESA, AZ OMAHA (DOUGLAS) Boys Town National Research Hospital 555 NORTH 30TH ST (402) FAX: (402) FATHER FLANAGAN'S BOYS' HOME JOHN ARCH, ADMINISTRATOR HOSP-CHD Medicare/Medicaid - 31 Total Lic - 31 BRANCH/EXTENSION/OFFSITE: BOYS TOWN MEDICAL OFFICE BUILDING STE BOYS TOWN HOSPITAL RD, BOYS TOWN

17 Page 16 of 24 OMAHA (DOUGLAS) CHI Health Bergan Mercy 7500 MERCY RD (402) FAX: (402) ALEGENT HEALTH MARIE KNEDLER, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH CORE LAB F ST, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH WOUND CARE CENTER MERCY RD, STE 502, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH LAKESIDE LABORATORY LAKESIDE HILLS CT, STE 108, OMAHA BRANCH/EXTENSION/OFFSITE: CHI HEALTH BERGAN MERCY SLEEP DISORDER CLINIC WEBSTER STREET, STE 2, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH BERGAN MOB PHYSICAL THERAPY MERCY RD STE 226, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH THORACIC & CARDIOVASCULAR SURGERY NICHOLAS ST, STE 250, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH P STREET CLINIC P ST, OMAHA BRANCH/EXTENSION/OFFSITE: LASTING HOPE RECOVERY CENTER S 25TH AVE, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH LAVISTA PHYSICAL THERAPY SOUTH 96TH ST, STE 102, LA VISTA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH SOUTH OMAHA PHYSICAL THERAPY L ST, OMAHA OMAHA (DOUGLAS) CHI Health Creighton University Medical Center H NORTH 30TH ST (402) FAX: (402) ALEGENT CREIGHTON HEALTH CREIGHTON UNIVERSITY MEDI KEVIN NOKELS, ADMINISTRATOR Medicare/Medicaid Total Lic OMAHA (DOUGLAS) CHI Health Immanuel 6901 NORTH 72ND ST (402) FAX: (402) ALEGENT HEALTH ANN SCHUMACHER, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: PARTIAL HOSPITALIZATION & OUTPT PSYCHIATRIC SERVIC NEWPORT AVE, STES 100, 101, O BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH PSYCHIATRIC ASSOCIATES NEWPORT AVE, STE 301, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH PSYCHIATRIC ASSOCIATES SAMPSON WAY, STE 203, BELLEVUE BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH PSYCHIATRIC ASSOCIATES LAKESIDE HILLS CT, STE 400, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH PSYCHIATRIC ASSOCIATES S 75TH ST, STE 100, OMAHA BRANCH/EXTENSION/OFFSITE: CHI HEALTH WEST MAPLE PHYSICAL THERAPY EVANS STREET, STE 102, OMAHA BRANCH/EXTENSION/OFFSITE: PARTIAL HOSPITALIZATION & OUTPT PSYCHIATRIC SERVIC NEWPORT AVE, STES 207, 208, O BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH PSYCHIATRIC ASSOCIATES SOUTH 84TH ST, STE 3841, PAPILLION BRANCH/EXTENSION/OFFSITE: PARTIAL HOSPITALIZATION & OUTPT PSYCHIATRIC SERVIC NEWPORT AVE, STE 305, OMAHA BRANCH/EXTENSION/OFFSITE: PARTIAL HOSPITALIZATION & OUTPT PSYCHIATRIC SERVIC NEWPORT AVE, STE 311, OMAHA BRANCH/EXTENSION/OFFSITE: PARTIAL HOSPITALIZATION & OUTPT PSYCHIATRIC SERVIC NEWPORT AVE, STES 202, 203, O BRANCH/EXTENSION/OFFSITE: ALEGENT HEALTH PHYSICAL THERAPY FLORENCE NORTH 30TH ST, OMAHA

18 Page 17 of 24 OMAHA (DOUGLAS) CHI Health Lakeside LAKESIDE HILLS CT (402) FAX: (402) ALEGENT HEALTH CINDY ALLOWAY, ADMINISTRATOR H Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: LAKESIDE HOSPITAL OUTPATIENT CARDIAC REHAB LAKESIDE HILLS CT, STE 100, OMAHA BRANCH/EXTENSION/OFFSITE: LAKESIDE HOSPITAL OUTPATIENT PHYSICAL THERAPY LAKESIDE HILLS PLAZA STE 109, OM BRANCH/EXTENSION/OFFSITE: ALEGENT MIDWEST CANCER CENTER WRIGHT ST STE 201, OMAHA BRANCH/EXTENSION/OFFSITE: LAKESIDE HOSPITAL SLEEP DISORDERS CLINIC LAKESIDE HILLS CT STE 110, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT CANCER CENTER ONCOLOGY SERVICE WRIGHT ST STE 102, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT CANCER CENTER IMAGE RECOVERY WRIGHT ST STE 202, OMAHA BRANCH/EXTENSION/OFFSITE: ALEGENT MIDWEST CANCER IMAGING WRIGHT ST STE 100, OMAHA BRANCH/EXTENSION/OFFSITE: LAKESIDE HOSPITAL CENTRAL IV STERILE MFG PHARMACY FRANCES STREET STE 103, OMA BRANCH/EXTENSION/OFFSITE: ALEGENT CANCER CENTER RADIATION/ONCOLOGY WRIGHT ST STE 101, OMAHA OMAHA (DOUGLAS) Children's Hospital & Medical Center 8200 DODGE ST (402) FAX: (402) CHILDREN'S HOSPITAL & MEDICAL CENTER GARY PERKINS, ADMINISTRATOR HOSP-CHD Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: CHILDREN'S HOSPITAL REHAB, LAB & RADIOLOGY SERVICE N 175TH ST, STE 1000, WEST VILLA BRANCH/EXTENSION/OFFSITE: CHILDREN'S PHYSICIANS GILES RD, STE 1, LA VISTA BRANCH/EXTENSION/OFFSITE: CHILDREN'S S P C - HEALTH CARE CLINIC N 84TH ST, OMAHA BRANCH/EXTENSION/OFFSITE: CHILDREN'S HOSPITAL EATING DISORDERS PROGRAM N 90TH ST, STE 300, OMAHA OMAHA (DOUGLAS) Douglas County Community Mental Health Center 4102 WOOLWORTH AVE (402) FAX: (402) DOUGLAS COUNTY SHERRY GLASNAPP, ADMINISTRATOR PSYCH AOA Medicare/Medicaid - 16 Total Lic - 16 OMAHA (DOUGLAS) Lasting Hope Recovery Center H SOUTH 25TH AVENUE (402) FAX: (402) ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM MARIE KNEDLER, ADMINISTRATOR Medicare/Medicaid - 64 Total Lic - 64

19 Page 18 of 24 OMAHA (DOUGLAS) Methodist Women's Hospital 707 NORTH 190TH PLAZA (402) FAX: (402) NEBRASKA METHODIST HOSPITAL SUSAN KORTH, ADMINISTRATOR H Medicare/Medicaid Total Lic % THE NEBRASKA METHODIST HOSPITAL, 8303 DODGE ST, OMAHA, NE OMAHA (DOUGLAS) Midwest Surgical Hospital L L C 7915 FARNAM DRIVE (402) FAX: (402) MIDWEST SURGICAL HOSPITAL, LLC CHARLES LIVINGSTON, ADMINISTRATOR H Medicare/Medicaid - 19 Total Lic - 19 OMAHA (DOUGLAS) Nebraska Orthopaedic Hospital 2808 SOUTH 143RD PLZ (402) FAX: (402) OUTLOOK, LLC/NEBRASKA MEDICAL CENTER LEVI SCHEPPERS, ADMINISTRATOR H Medicare/Medicaid - 24 Total Lic - 24 BRANCH/EXTENSION/OFFSITE: OUTPATIENT PHYSICAL/OCCUPATIONAL THERAPY SOUTH 144TH ST, STE 218, OMAHA BRANCH/EXTENSION/OFFSITE: AQUATIC PHYSICAL THERAPY SOUTH 144TH ST, STE 114, OMAHA BRANCH/EXTENSION/OFFSITE: PERFORMANCE & CONDITIONING CENTER SOUTH 144TH ST, STE 116, OMAHA BRANCH/EXTENSION/OFFSITE: M R I SERVICES SOUTH 144TH ST, STE 118, OMAHA BRANCH/EXTENSION/OFFSITE: EMERGENCY DEPARTMENT S 144TH ST, STE 150, OMAHA BRANCH/EXTENSION/OFFSITE: OUTPATIENT SURGERY S 144TH ST, STE 180, OMAHA BRANCH/EXTENSION/OFFSITE: INFUSION CENTER S 144TH ST, STE 260, OMAHA BRANCH/EXTENSION/OFFSITE: SHORT STAY UNIT S 144TH ST, STE 170, OMAHA OMAHA (DOUGLAS) Nebraska Spine Hospital P O BOX 34400, 6901 NORTH 72ND ST, STE (402) FAX: (402) NEBRASKA SPINE HOSPITAL, LLC CORY KRUGER, INTERIM ADMINIS H Medicare/Medicaid - 34 Total Lic - 34

20 Page 19 of 24 OMAHA (DOUGLAS) Select Specialty Hospital - Omaha (Central Campus) 1870 SOUTH 75TH STREET (402) FAX: (402) SELECT SPECIALTY HOSPITAL - OMAHA, INC. THOMAS THEROULT, ADMINISTRATOR HOSP-LT H Medicare - 52 Medicare/ Total Lic - 52 % ATTN: MELANIE NOTARIO, SELECT SPECIALTY MEDICAL, 4714 GETTYSBURG RD MECHANICSBURG, PA OMAHA (DOUGLAS) The Nebraska Medical Center DBA Nebraska Medici NEBRASKA MEDICAL CENTER (402) FAX: (402) THE NEBRASKA MEDICAL CENTER ROSANNA MORRIS, INTERIM ADMINIS Medicare/Medicaid Total Lic % THE NEBRASKA MEDICAL CENTER, NEBRASKA MEDICAL CENTER, OMAHA, NE BRANCH/EXTENSION/OFFSITE: NEBRASKA MEDICAL CENTER LABORATORY S 144TH ST, STE 160, OMAHA BRANCH/EXTENSION/OFFSITE: NEBRASKA MEDICAL CENTER RADIOLOGY S 144TH ST, STE 120, OMAHA BRANCH/EXTENSION/OFFSITE: NEBRASKA MEDICAL CENTER CARDIOLOGY IMAGING S 144TH ST, STE 290, OMAHA BRANCH/EXTENSION/OFFSITE: THE CANCER CENTER AT VILLAGE POINT MEDICAL CENTER N 175TH ST, OMAHA BRANCH/EXTENSION/OFFSITE: NEBRASKA MEDICAL CENTER BELLEVUE CANCER SERVICES BELLEVUE MEDICAL CENTER DR BRANCH/EXTENSION/OFFSITE: NEBRASKA MEDICAL CENTER BELLEVUE PHARMACY BELLEVUE MEDICAL CENTER DR, STE 10 BRANCH/EXTENSION/OFFSITE: NEBRASKA MEDICAL CENTER BELLEVUE CANCER SERVICES BELLEVUE MEDICAL CENTER DR BRANCH/EXTENSION/OFFSITE: NEBRASKA MEDICAL CENTER VILLAGE POINT ENDOSCOPY CE N 175TH ST, OMAHA OMAHA (DOUGLAS) The Nebraska Methodist Hospital 8303 DODGE ST (402) FAX: (402) NEBRASKA METHODIST HEALTH SYSTEM STEPHEN GOESER, ADMINISTRATOR Medicare/Medicaid Total Lic BRANCH/EXTENSION/OFFSITE: METHODIST HEALTHWEST WEST DODGE RD, OMAHA BRANCH/EXTENSION/OFFSITE: METHODIST HOSPITAL PAIN MANAGEMENT CLINIC N 162ND AVE, STE 203, OMAHA BRANCH/EXTENSION/OFFSITE: PATHOLOGY, ONCOLOGY, W DODGE IMAGING N 162ND AVE, STE 100, OMAHA BRANCH/EXTENSION/OFFSITE: METHODIST HOSPITAL SLEEP CENTER N 162ND AVE, STE 103, OMAHA BRANCH/EXTENSION/OFFSITE: METHODIST HOSPITAL PERINATAL CENTER WEST DODGE RD, STE 200A, OMAHA BRANCH/EXTENSION/OFFSITE: METHODIST HOSPITAL WOUND CENTER N 162ND AVE, STE 301, OMAHA BRANCH/EXTENSION/OFFSITE: RENAISSANCE HEALTH CLINIC CUMING ST, OMAHA BRANCH/EXTENSION/OFFSITE: METHODIST HOSPITAL PERINATAL CENTER N 190TH PLAZA, STE 2400, ELKHORN

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