Provider Demographics
NPI:1841395126
Name:FAITH REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:FAITH REGIONAL HEALTH SERVICES
Other - Org Name:FAITH REGIONAL HOME HEALTH SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-371-4880
Mailing Address - Street 1:PO BOX 869
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68702-0869
Mailing Address - Country:US
Mailing Address - Phone:402-644-7249
Mailing Address - Fax:402-644-7432
Practice Address - Street 1:2622 W NORFOLK AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4423
Practice Address - Country:US
Practice Address - Phone:402-644-7453
Practice Address - Fax:402-644-7432
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-13
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE521001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE5000020OtherUHC HOME HEALTH
NE00540OtherBCBS HOME HEALTH
NE0006400415OtherAETNA HOME HEALTH
NE0006400415OtherAETNA HOME HEALTH
NE00540OtherBCBS HOME HEALTH
NE287089Medicare Oscar/Certification