Provider Demographics
NPI:1114437340
Name:HEAD START CFDP, INC.
Entity Type:Organization
Organization Name:HEAD START CFDP, INC.
Other - Org Name:HEAD START
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JODE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KINNAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-462-4187
Mailing Address - Street 1:123 N MARIAN RD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-4673
Mailing Address - Country:US
Mailing Address - Phone:402-462-4187
Mailing Address - Fax:402-462-4568
Practice Address - Street 1:123 N MARIAN RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4673
Practice Address - Country:US
Practice Address - Phone:402-462-4187
Practice Address - Fax:402-462-4568
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEAD START
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43973163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty