Provider Demographics
NPI:1750320859
Name:FREMONT HEALTH
Entity Type:Organization
Organization Name:FREMONT HEALTH
Other - Org Name:DUNKLAU GARDENS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-721-1610
Mailing Address - Street 1:450 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2387
Mailing Address - Country:US
Mailing Address - Phone:402-721-1610
Mailing Address - Fax:402-727-3433
Practice Address - Street 1:450 E 23RD ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2387
Practice Address - Country:US
Practice Address - Phone:402-727-3795
Practice Address - Fax:402-727-3333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREMONT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2015-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELTCH011314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00251OtherBLUE CROSS BLUE SHIELD
NE=========02Medicaid
NE00251OtherBLUE CROSS BLUE SHIELD