Provider Demographics
NPI:1912009374
Name:DOUGLAS COUNTY NEBRASKA
Entity Type:Organization
Organization Name:DOUGLAS COUNTY NEBRASKA
Other - Org Name:DOUGLAS COUNTY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARTNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-444-7301
Mailing Address - Street 1:4102 WOOLWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-1899
Mailing Address - Country:US
Mailing Address - Phone:402-444-7000
Mailing Address - Fax:402-444-7369
Practice Address - Street 1:4102 WOOLWORTH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1899
Practice Address - Country:US
Practice Address - Phone:402-444-7000
Practice Address - Fax:402-444-7369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOUGLAS COUNTY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-05
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE264024332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-62Medicaid
NE=========-62Medicaid