Provider Demographics
NPI:1669648333
Name:GRACE CHILDRENS HOME INC
Entity Type:Organization
Organization Name:GRACE CHILDRENS HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:RADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-723-5725
Mailing Address - Street 1:1033 N MAIN
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-0519
Mailing Address - Country:US
Mailing Address - Phone:402-723-5725
Mailing Address - Fax:402-723-5718
Practice Address - Street 1:1033 N MAIN
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-0519
Practice Address - Country:US
Practice Address - Phone:402-723-5725
Practice Address - Fax:402-723-5718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid