Provider Demographics
NPI:1073716544
Name:CHILDREN'S RESPITE CARE CENTER
Entity Type:Organization
Organization Name:CHILDREN'S RESPITE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-895-4000
Mailing Address - Street 1:5321 S 138TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2913
Mailing Address - Country:US
Mailing Address - Phone:402-895-4000
Mailing Address - Fax:402-895-1607
Practice Address - Street 1:5321 S 138TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2913
Practice Address - Country:US
Practice Address - Phone:402-895-4000
Practice Address - Fax:402-895-1607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025296600Medicare ID - Type Unspecified