1902287261 NPI number — GOOD NEIGHBOR COMMUNITY HEALTH CENTER

Table of content: (NPI 1902287261)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902287261 NPI number — GOOD NEIGHBOR COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD NEIGHBOR COMMUNITY HEALTH CENTER
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:
GOOD NEIGHBOR CLINIC FREMONT
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:
1902287261
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4321 41ST AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68601-2131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-562-8952
Provider Business Mailing Address Fax Number:
402-564-0611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2740 N CLARKSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREMONT
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68025-7716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-721-0951
Provider Business Practice Location Address Fax Number:
402-721-0804
Provider Enumeration Date:
06/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FORD-WOLFGRAM
Authorized Official First Name:
TERRI
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
402-562-7500

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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)





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