Provider Demographics
NPI:1629530373
Name:CHARLES DREW HEALTH CENTER INC
Entity Type:Organization
Organization Name:CHARLES DREW HEALTH CENTER INC
Other - Org Name:CHARLES DREW HEALTH CENTER, INC. AT OMAHA HOME FOR BOYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:TARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:402-457-1215
Mailing Address - Street 1:5190 SPRAGUE PLZ STE 201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2891
Mailing Address - Country:US
Mailing Address - Phone:402-452-3725
Mailing Address - Fax:402-939-0905
Practice Address - Street 1:5190 SPRAGUE PLZ STE 201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2891
Practice Address - Country:US
Practice Address - Phone:402-452-3725
Practice Address - Fax:402-939-0905
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES DREW HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-02
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)