Provider Demographics
| NPI: | 1104854199 |
|---|---|
| Name: | FAITH REGIONAL HEALTH SERVICES |
| Entity type: | Organization |
| Organization Name: | FAITH REGIONAL HEALTH SERVICES |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT/CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | KELLY |
| Authorized Official - Middle Name: | A |
| Authorized Official - Last Name: | DRISCOLL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 402-371-4880 |
| Mailing Address - Street 1: | PO BOX 869 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | NORFOLK |
| Mailing Address - State: | NE |
| Mailing Address - Zip Code: | 68702-0869 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 402-644-7249 |
| Mailing Address - Fax: | 402-644-7432 |
| Practice Address - Street 1: | 2700 W NORFOLK AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | NORFOLK |
| Practice Address - State: | NE |
| Practice Address - Zip Code: | 68701-4438 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 402-371-4880 |
| Practice Address - Fax: | 402-644-7432 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | FAITH REGIONAL HEALTH SERVICES |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-06-29 |
| Last Update Date: | 2021-07-28 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 133V00000X | Dietary & Nutritional Service Providers | Dietitian, Registered | Group - Multi-Specialty | |
| No | 163WD0400X | Nursing Service Providers | Registered Nurse | Diabetes Educator | Group - Multi-Specialty |
| No | 163WL0100X | Nursing Service Providers | Registered Nurse | Lactation Consultant | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NE | 31338 | Other | BCBS ER GROUP |
| NE | 10025533600 | Medicaid | |
| NE | 36887 | Other | BCBS DME |
| IA | 0544858 | Medicaid | |
| NE | 10025533500 | Medicaid | |
| NE | 81002 | Other | ZWIENER ONLY |
| IA | 0538280 | Medicaid | |
| IA | 0544858 | Medicaid | |
| NE | =========27 | Medicaid | |
| =========002 | Other | TRICARE ER GROUP | |
| NE | =========32 | Medicaid | |
| NE | 31338 | Other | BCBS ER GROUP |
| NE | 81002 | Other | ZWIENER ONLY |
| NE | =========13 | Medicaid | |
| NE | =========63 | Medicaid | |
| NE | =========11 | Medicaid | |
| NE | 81002 | Other | ZWIENER ONLY |
| NE | =========13 | Medicaid |
