Provider Demographics
NPI:1922463926
Name:COMPLETE FAMILY CARE LLC
Entity Type:Organization
Organization Name:COMPLETE FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:LEAL
Authorized Official - Last Name:CASTANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-675-1931
Mailing Address - Street 1:908 N HOWARD AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3556
Mailing Address - Country:US
Mailing Address - Phone:308-675-1931
Mailing Address - Fax:
Practice Address - Street 1:908 N HOWARD AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3556
Practice Address - Country:US
Practice Address - Phone:308-675-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110175363LF0000X
NE39208363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026009700Medicaid
NE275897Medicare PIN