Healthcare Provider Details

I. General information

NPI: 1790032191
Provider Name (Legal Business Name): FREMONT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2012
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-2303
US

IV. Provider business mailing address

450 E 23RD ST
FREMONT NE
68025-2303
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-1610
  • Fax: 402-727-3433
Mailing address:
  • Phone: 402-721-1610
  • Fax: 402-727-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberHOSPICE 9
License Number StateNE

VIII. Authorized Official

Name: MR. PATRICK M BOOTH
Title or Position: PRESIDENT/CEO
Credential:
Phone: 402-721-1610