1912901505 NPI number — CHRISTIAN HOMES, INC.

Table of content: (NPI 1912901505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912901505 NPI number — CHRISTIAN HOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN HOMES, INC.
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:
CHRISTIAN HOMES HEALTH CARE, CHRISOMA WEST
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:
1912901505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1923 W 4TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLDREGE
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68949-3113
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-995-4493
Provider Business Mailing Address Fax Number:
308-995-8702

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1923 WEST 4TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLDREGE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68949-3113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-995-4493
Provider Business Practice Location Address Fax Number:
308-995-8702
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BAKKE
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
308-995-4493

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  ALF030 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 614002 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28D0652676 . This is a "CLIA NUMBER" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 614002 . This is a "NEBRASKA SKILLED LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: ALF030 . This is a "NE ASSISTED LIV. LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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