Provider Demographics
NPI:1962441196
Name:FREMONT HEALTH
Entity Type:Organization
Organization Name:FREMONT HEALTH
Other - Org Name:FREMONT HEALTH HOME CARE
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 1:2400 N LINCOLN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2443
Practice Address - Country:US
Practice Address - Phone:402-721-1699
Practice Address - Fax:402-941-1688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREMONT HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251001251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========01Medicaid
NE287016Medicare Oscar/Certification