Provider Demographics
NPI:1285359000
Name:ADVANCED FAMILY HEALTHCARE LLC
Entity type:Organization
Organization Name:ADVANCED FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:TAMAKA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GANGWISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-303-8802
Mailing Address - Street 1:926 EAST 'E' ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:926 E E ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6617
Practice Address - Country:US
Practice Address - Phone:402-303-8802
Practice Address - Fax:402-487-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center