Provider Demographics
NPI:1265536395
Name:FAITH REGIONAL HEALTH SERVICES
Entity type:Organization
Organization Name:FAITH REGIONAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2622 W NORFOLK AVE STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4423
Practice Address - Country:US
Practice Address - Phone:402-644-7453
Practice Address - Fax:402-644-7432
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAITH REGIONAL HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-11
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHOSPICE 18251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE00542OtherBCBS HOSPICE
NE5000020OtherUHC HOSPICE
NE0006400415OtherAETNA HOSPICE
NE10025139900Medicaid
NE=========79Medicaid
NE=========70Medicaid
NE=========001OtherTRICARE HOSPICE
NE=========72Medicaid
NE0006400415OtherAETNA HOSPICE
NE=========74Medicaid
NE=========76Medicaid
NE=========78Medicaid
NE=========73Medicaid
NE=========75Medicaid
NE=========77Medicaid
NE=========80Medicaid
NE=========76Medicaid