Healthcare Provider Details

I. General information

NPI: 1922463926
Provider Name (Legal Business Name): COMPLETE FAMILY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2015
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N HOWARD AVE SUITE 108
GRAND ISLAND NE
68803-3556
US

IV. Provider business mailing address

908 N HOWARD AVE SUITE 108
GRAND ISLAND NE
68803-3556
US

V. Phone/Fax

Practice location:
  • Phone: 308-675-1931
  • Fax:
Mailing address:
  • Phone: 308-675-1931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110175
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number39208
License Number StateNE

VIII. Authorized Official

Name: MR. MALCOLM LEAL CASTANEDA
Title or Position: MANAGER
Credential:
Phone: 308-675-1931