Provider Demographics
NPI:1396269726
Name:FATHER FLANAGAN'S BOYS HOME
Entity type:Organization
Organization Name:FATHER FLANAGAN'S BOYS HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:531-355-3362
Mailing Address - Street 1:14188 MOTHER TERESA LN
Mailing Address - Street 2:
Mailing Address - City:BOYS TOWN
Mailing Address - State:NE
Mailing Address - Zip Code:68010-7554
Mailing Address - Country:US
Mailing Address - Phone:402-498-3025
Mailing Address - Fax:402-964-7150
Practice Address - Street 1:14188 MOTHER TERESA LN
Practice Address - Street 2:
Practice Address - City:BOYS TOWN
Practice Address - State:NE
Practice Address - Zip Code:68010-7554
Practice Address - Country:US
Practice Address - Phone:402-498-3025
Practice Address - Fax:402-964-7150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-27
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026522510Medicaid