Provider Demographics
NPI:1710990577
Name:HENDERSON HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:HENDERSON HEALTH CARE SERVICES, INC.
Other - Org Name:HENDERSON FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-723-4512
Mailing Address - Street 1:1621 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NE
Mailing Address - Zip Code:68371-8902
Mailing Address - Country:US
Mailing Address - Phone:402-723-4512
Mailing Address - Fax:402-723-4520
Practice Address - Street 1:1621 FRONT ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NE
Practice Address - Zip Code:68371-8902
Practice Address - Country:US
Practice Address - Phone:402-723-4512
Practice Address - Fax:402-723-4520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========21Medicaid
NE=========12Medicaid
NE283421Medicare Oscar/Certification