Healthcare Provider Details

I. General information

NPI: 1043114929
Provider Name (Legal Business Name): FRIENDS OF CEDAR RIVER RASCALS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 NARAGANSETT ST
ERICSON NE
68637-8049
US

IV. Provider business mailing address

205 NARAGANSETT ST
ERICSON NE
68637-8049
US

V. Phone/Fax

Practice location:
  • Phone: 308-750-0522
  • Fax:
Mailing address:
  • Phone: 308-750-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: COURTNEY PAPPAS
Title or Position: PRIMARY CARE PROVIDER
Credential:
Phone: 605-877-1850