Provider Demographics
NPI:1275029209
Name:GOOD NEIGHBOR COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:GOOD NEIGHBOR COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-562-8955
Mailing Address - Street 1:4321 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-2131
Mailing Address - Country:US
Mailing Address - Phone:402-562-7500
Mailing Address - Fax:402-564-0611
Practice Address - Street 1:4321 41ST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-2131
Practice Address - Country:US
Practice Address - Phone:402-532-7500
Practice Address - Fax:402-564-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE4935122300000X
261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063510200Medicaid