| Family Network | |
|
1811 W 2nd St Suite 330 Grand Island NE 68803-5413 | |
| (308) 382-8085 | |
| (308) 382-2582 |
| Full Name | Family Network |
|---|---|
| Speciality | Counselor |
| Location | 1811 W 2nd St, Grand Island, Nebraska |
| Authorized Official Name and Position | Kaye Mindt Long (SOLE PROPRIETOR) |
| Authorized Official Contact | 3083828085 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Network 1811 W 2nd St Suite 330 Grand Island NE 68803-5413 Ph: (308) 382-8085 | Family Network 1811 W 2nd St Suite 330 Grand Island NE 68803-5413 Ph: (308) 382-8085 |
| NPI Number | 1124399464 |
|---|---|
| Provider Enumeration Date | 01/18/2012 |
| Last Update Date | 01/18/2012 |
| Medicare PECOS PAC ID | 0547427502 |
|---|---|
| Medicare Enrollment ID | O20120202000073 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124399464 | NPI | - | NPPES |
| 10026098900 | Medicaid | NE | |
| 260662 | Other | NE | PTAN MDCR (ORIGINAL) |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | 320,787, AND 511 (Nebraska) | Primary |
| Provider Name | Wanda K Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720134844 PECOS PAC ID: 8628235694 Enrollment ID: I20120202000100 |
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