Healthcare Provider Details

I. General information

NPI: 1750320859
Provider Name (Legal Business Name): FREMONT HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 01/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 23RD ST
FREMONT NE
68025-2387
US

IV. Provider business mailing address

450 E 23RD ST
FREMONT NE
68025-2387
US

V. Phone/Fax

Practice location:
  • Phone: 402-727-3795
  • Fax: 402-727-3333
Mailing address:
  • Phone: 402-721-1610
  • Fax: 402-727-3433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberLTCH011
License Number StateNE

VIII. Authorized Official

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