Provider Demographics
NPI:1154895225
Name:CHARLES DREW HEALTH CENTER INC
Entity type:Organization
Organization Name:CHARLES DREW HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRINGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-457-1215
Mailing Address - Street 1:2915 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3863
Mailing Address - Country:US
Mailing Address - Phone:402-810-9762
Mailing Address - Fax:402-939-0916
Practice Address - Street 1:5319 N 30TH ST STE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-1604
Practice Address - Country:US
Practice Address - Phone:402-457-1216
Practice Address - Fax:402-453-2061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES DREW HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-01-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026276413OtherMEDICAID NON FQHC
NE10026276407Medicaid