| Charles Drew Health Center, Inc. At Omaha Home For Boys | |
|
5190 Sprague Plz Ste 201 Omaha NE 68104-2891 | |
| (402) 452-3725 | |
| (402) 939-0905 |
| Full Name | Charles Drew Health Center, Inc. At Omaha Home For Boys |
|---|---|
| Speciality | Clinic/Center |
| Location | 5190 Sprague Plz Ste 201, Omaha, Nebraska |
| Authorized Official Name and Position | Tarsha Jackson (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 4024571215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles Drew Health Center, Inc. At Omaha Home For Boys 5190 Sprague Plz Ste 201 Omaha NE 68104-2891 Ph: (402) 452-3725 | Charles Drew Health Center, Inc. At Omaha Home For Boys 5190 Sprague Plz Ste 201 Omaha NE 68104-2891 Ph: (402) 452-3725 |
| NPI Number | 1629530373 |
|---|---|
| Provider Enumeration Date | 04/02/2019 |
| Last Update Date | 03/19/2021 |
| Medicare PECOS PAC ID | 9830170653 |
|---|---|
| Medicare Enrollment ID | O20190422000563 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629530373 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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