Provider Demographics
NPI:1932600038
Name:SHILOH CENTER ADULT DAY SERVICES
Entity Type:Organization
Organization Name:SHILOH CENTER ADULT DAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-208-8859
Mailing Address - Street 1:114 E MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-5066
Mailing Address - Country:US
Mailing Address - Phone:402-208-8859
Mailing Address - Fax:402-721-9170
Practice Address - Street 1:114 E MILITARY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-5066
Practice Address - Country:US
Practice Address - Phone:402-208-8859
Practice Address - Fax:402-721-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE310400000XMedicaid