Provider Demographics
NPI:1407150394
Name:NEHEMIAH FAMILY SERVICES
Entity Type:Organization
Organization Name:NEHEMIAH FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CD PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:507-374-9047
Mailing Address - Street 1:PO BOX 335
Mailing Address - Street 2:
Mailing Address - City:DODGE CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55927-0335
Mailing Address - Country:US
Mailing Address - Phone:507-374-9047
Mailing Address - Fax:507-633-2977
Practice Address - Street 1:104 1ST ST NW
Practice Address - Street 2:
Practice Address - City:DODGE CENTER
Practice Address - State:MN
Practice Address - Zip Code:55927-9195
Practice Address - Country:US
Practice Address - Phone:507-374-9047
Practice Address - Fax:507-633-2977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1013043-5-CDT261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder