Healthcare Provider Details

I. General information

NPI: 1396269726
Provider Name (Legal Business Name): FATHER FLANAGAN'S BOYS HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2017
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14188 MOTHER TERESA LN
BOYS TOWN NE
68010-7554
US

IV. Provider business mailing address

14188 MOTHER TERESA LN
BOYS TOWN NE
68010-7554
US

V. Phone/Fax

Practice location:
  • Phone: 402-498-3025
  • Fax: 402-964-7150
Mailing address:
  • Phone: 402-498-3025
  • Fax: 402-964-7150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA BLAINE
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 531-355-3362