1265405419 NPI number — FATHER FLANAGAN'S BOYS HOME

Table of content: (NPI 1265405419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265405419 NPI number — FATHER FLANAGAN'S BOYS HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FATHER FLANAGAN'S BOYS HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BOYS TOWN CENTER FOR BEHAVIORAL HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265405419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13460 WALSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOYS TOWN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68010-7529
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
531-355-3358
Provider Business Mailing Address Fax Number:
531-355-3375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13460 WALSH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOYS TOWN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68010-7529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-498-3362
Provider Business Practice Location Address Fax Number:
402-398-3375
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHEARMAN
Authorized Official First Name:
STACIA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
531-355-8104

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100255507-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100261374-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100260944-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100262511-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100255156-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100261397-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100262510-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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