Provider Demographics
NPI:1962427781
Name:EPWORTH VILLAGE, INC.
Entity type:Organization
Organization Name:EPWORTH VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-362-3353
Mailing Address - Street 1:PO BOX 503
Mailing Address - Street 2:2119 DIVISION AVE.
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-0503
Mailing Address - Country:US
Mailing Address - Phone:402-362-3353
Mailing Address - Fax:
Practice Address - Street 1:2119 N DIVISION AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-1009
Practice Address - Country:US
Practice Address - Phone:402-362-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE79772233323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100260387-00Medicaid
NE100260389-00Medicaid
NE100260401-00Medicaid
NE100260386-00Medicaid
NE100260591-00Medicaid
NE100260385-00Medicaid