Provider Demographics
NPI:1811901622
Name:PAPILLION CHRISTIAN CENTER, INC
Entity type:Organization
Organization Name:PAPILLION CHRISTIAN CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP/CPC
Authorized Official - Phone:402-331-3477
Mailing Address - Street 1:1301 GOLD COAST RD
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2826
Mailing Address - Country:US
Mailing Address - Phone:402-331-3477
Mailing Address - Fax:402-331-3557
Practice Address - Street 1:1301 GOLD COAST RD
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2826
Practice Address - Country:US
Practice Address - Phone:402-331-3477
Practice Address - Fax:402-331-3557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid