Provider Demographics
NPI:1811247299
Name:ST BENEDICT THE MOOR CATHOLIC CHURCH
Entity type:Organization
Organization Name:ST BENEDICT THE MOOR CATHOLIC CHURCH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD MEMBER BRYANT CENTER ASSOCIAT
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:GLASS
Authorized Official - Last Name:UNION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-884-2605
Mailing Address - Street 1:2423 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111
Mailing Address - Country:US
Mailing Address - Phone:402-844-2605
Mailing Address - Fax:
Practice Address - Street 1:2423 GRANT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111
Practice Address - Country:US
Practice Address - Phone:402-844-2605
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. BENEDICT THE MOOR CATHOLIC CHURCH/BRYANT CENTER ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE#928104100000X
NE#2859103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty