Provider Demographics
NPI:1013012442
Name:FAITH REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:FAITH REGIONAL HEALTH SERVICES
Other - Org Name:
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:2006-09-13
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE520001273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5000020OtherUNITED HEALTHCARE ARU
NE0006400415OtherAETNA ARU
NE10025230500Medicaid
NE60064OtherBCBS ARU
NE5000020OtherUNITED HEALTHCARE ARU
NE10025230500Medicaid
NE5000020OtherUNITED HEALTHCARE ARU