Healthcare Provider Details

I. General information

NPI: 1982913943
Provider Name (Legal Business Name): COMMUNITY ACTION PARTNERSHIP OF WESTERN NEBRASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 CRESCENT DR
GERING NE
69341-1712
US

IV. Provider business mailing address

3350 10TH ST
GERING NE
69341-1724
US

V. Phone/Fax

Practice location:
  • Phone: 308-632-2540
  • Fax: 308-633-2650
Mailing address:
  • Phone: 308-635-3089
  • Fax: 308-635-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberHC023
License Number StateNE

VIII. Authorized Official

Name: MS. JAN FITTS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 308-635-3089