FATHER FLANAGANS BOYS HOME

Provider Demographics

• NPI: 1235795568
• Name: FATHER FLANAGANS BOYS HOME
• Entity Type: Organization
• Organization Name: FATHER FLANAGANS BOYS HOME
• Authorized Official - Title/Position: CFO
• Authorized Official - First Name: JUDY
• Authorized Official - Middle Name: F
• Authorized Official - Last Name: RASMUSSEN
• Authorized Official - Phone: 531-355-3131
• Mailing Address - Street 1: 555 N 30TH ST
• Mailing Address - City: OMAHA
• Mailing Address - State: NE
• Mailing Address - Zip Code: 68131-2136
• Mailing Address - Country: US
• Mailing Address - Phone: 531-355-6509
• Mailing Address - Fax: 531-355-6357
• Practice Address - Street 1: 555 N 30TH ST
• Practice Address - City: OMAHA
• Practice Address - State: NE
• Practice Address - Zip Code: 68131-2136
• Practice Address - Country: US
• Practice Address - Phone: 531-355-6509
• Practice Address - Fax: 531-355-6357
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: FATHER FLANAGAN'S BOYS HOME
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2019-05-13
• Last Update Date: 2019-05-13

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Multi-Specialty
No	207L00000X	Allopathic & Osteopathic Physicians	Anesthesiology		Group - Multi-Specialty
No	207SG0201X	Allopathic & Osteopathic Physicians	Medical Genetics	Clinical Genetics (M.D.)	Group - Multi-Specialty
No	207V00000X	Allopathic & Osteopathic Physicians	Obstetrics & Gynecology		Group - Multi-Specialty
No	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Multi-Specialty
No	207X00000X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery		Group - Multi-Specialty
No	207YP0228X	Allopathic & Osteopathic Physicians	Otolaryngology	Pediatric Otolaryngology	Group - Multi-Specialty
No	2080P0006X	Allopathic & Osteopathic Physicians	Pediatrics	Developmental - Behavioral Pediatrics	Group - Multi-Specialty
No	2080P0201X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Allergy/Immunology	Group - Multi-Specialty
No	2080P0206X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Gastroenterology	Group - Multi-Specialty
No	2080S0010X	Allopathic & Osteopathic Physicians	Pediatrics	Sports Medicine	Group - Multi-Specialty
No	2084P0804X	Allopathic & Osteopathic Physicians	Psychiatry & Neurology	Child & Adolescent Psychiatry	Group - Multi-Specialty
No	231H00000X	Speech, Language and Hearing Service Providers	Audiologist		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NE	10026522400	Medicaid