Provider Demographics
NPI:1982913943
Name:COMMUNITY ACTION PARTNERSHIP OF WESTERN NEBRASKA
Entity Type:Organization
Organization Name:COMMUNITY ACTION PARTNERSHIP OF WESTERN NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FITTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-635-3089
Mailing Address - Street 1:3350 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1724
Mailing Address - Country:US
Mailing Address - Phone:308-635-3089
Mailing Address - Fax:308-635-0264
Practice Address - Street 1:975 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1712
Practice Address - Country:US
Practice Address - Phone:308-632-2540
Practice Address - Fax:308-633-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHC023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY110289300Medicaid
NE10025346300Medicaid