Provider Demographics
NPI:1972608248
Name:FAITH REGIONAL HEALTH SERVICES
Entity Type:Organization
Organization Name:FAITH REGIONAL HEALTH SERVICES
Other - Org Name:ST. JOSEPH'S REHABILITATION AND CARE CENTER
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 1:401 N 18TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3686
Practice Address - Country:US
Practice Address - Phone:402-644-7375
Practice Address - Fax:402-379-4867
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:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF159310400000X
NE524007313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00688OtherBCBS
NE00688OtherBCBS
NE00688OtherBCBS