Provider Demographics
NPI:1114952363
Name:BOONE COUNTY HEALTH CENTER
Entity Type:Organization
Organization Name:BOONE COUNTY HEALTH CENTER
Other - Org Name:BOONE COUNTY HEALTH CENTER HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:K
Authorized Official - Last Name:POORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-395-3213
Mailing Address - Street 1:PO BOX 151
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:NE
Mailing Address - Zip Code:68620-0151
Mailing Address - Country:US
Mailing Address - Phone:402-395-3213
Mailing Address - Fax:402-395-3173
Practice Address - Street 1:632 W FAIRVIEW ST
Practice Address - Street 2:ROOM 4
Practice Address - City:ALBION
Practice Address - State:NE
Practice Address - Zip Code:68620-1724
Practice Address - Country:US
Practice Address - Phone:402-395-2191
Practice Address - Fax:402-395-5165
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOONE COUNTY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE031001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEF313OtherMIDLANDS CHOICE
NE00157OtherBCBS OF NEBRASKA
NE=========16Medicaid
NE=========16Medicaid