Provider Demographics
NPI:1194827550
Name:DOUGLAS COUNTY NEBRASKA
Entity Type:Organization
Organization Name:DOUGLAS COUNTY NEBRASKA
Other - Org Name:DOUGLAS COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-444-7041
Mailing Address - Street 1:4102 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1899
Mailing Address - Country:US
Mailing Address - Phone:402-444-7000
Mailing Address - Fax:402-444-7369
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1899
Practice Address - Country:US
Practice Address - Phone:402-444-7000
Practice Address - Fax:402-444-7369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS COUNTY NEBRASKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF205310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-07Medicaid
NE=========-08Medicaid
NE=========-11Medicaid
NE096581Medicare ID - Type UnspecifiedPART B-BC/BS OF KS
NE284009Medicare ID - Type UnspecifiedMUTUAL PART B
NE=========-08Medicaid