Provider Demographics
NPI:1700031028
Name:FAMILY ADVOCACY NETWORK
Entity Type:Organization
Organization Name:FAMILY ADVOCACY NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAEBERLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:308-865-7492
Mailing Address - Street 1:106 EAST 31ST STREET
Mailing Address - Street 2:P.O. BOX 1990
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1990
Mailing Address - Country:US
Mailing Address - Phone:308-865-7492
Mailing Address - Fax:308-865-2971
Practice Address - Street 1:106 E 31ST ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-3063
Practice Address - Country:US
Practice Address - Phone:308-865-7492
Practice Address - Fax:308-865-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19872261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center