Provider Demographics
NPI:1003818808
Name:FRIENDSHIP HOUSE, INC.
Entity Type:Organization
Organization Name:FRIENDSHIP HOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:LADAC
Authorized Official - Phone:308-382-0422
Mailing Address - Street 1:402 W KOENIG ST
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-6516
Mailing Address - Country:US
Mailing Address - Phone:308-382-0422
Mailing Address - Fax:308-382-6195
Practice Address - Street 1:402 W KOENIG ST
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-6516
Practice Address - Country:US
Practice Address - Phone:308-382-0422
Practice Address - Fax:308-382-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NESATC005324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility