1447622923 NPI number — FATHER FLANAGAN'S BOYS HOME

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447622923 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 BEHAVIORAL HEALTH CLINIC EAST
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:
1447622923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5074 AMES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68104-2323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-498-3358
Provider Business Mailing Address Fax Number:
402-498-3375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5074 AMES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68104-2323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-498-3358
Provider Business Practice Location Address Fax Number:
402-498-3375
Provider Enumeration Date:
10/23/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DALY
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
EXECUTIVE VP DIRECTOR YOUTH CARE
Authorized Official Telephone Number:
402-498-3362

Provider Taxonomy Codes

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

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

  • Identifier: 10026370000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026330000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com