1285676544 NPI number — FAITH REGIONAL HEALTH SERVICES

Table of content: (NPI 1285676544)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285676544 NPI number — FAITH REGIONAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAITH REGIONAL HEALTH SERVICES
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:
Provider Other Organization Name Type Code:
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:
1285676544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 869
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68702-0869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-644-7249
Provider Business Mailing Address Fax Number:
402-644-7432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 W NORFOLK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-4438
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-371-4880
Provider Business Practice Location Address Fax Number:
402-644-7432
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DRISCOLL
Authorized Official First Name:
KELLY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
402-371-4880

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  520002 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 520002 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 520001 , 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: 00517 . This is a "BCBS PSYCH" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 00519 . This is a "BCBS ACUTE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 118248000 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000020 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 71907866 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00521 . This is a "BCBS OP SA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0006400415 . This is a "AETNA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0130790 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0544858 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5530790 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 363673900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016120701 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0518050 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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