Healthcare Provider Details

I. General information

NPI: 1003818808
Provider Name (Legal Business Name): FRIENDSHIP HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 W KOENIG ST
GRAND ISLAND NE
68801-6516
US

IV. Provider business mailing address

402 W KOENIG ST
GRAND ISLAND NE
68801-6516
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-0422
  • Fax: 308-382-6195
Mailing address:
  • Phone: 308-382-0422
  • Fax: 308-382-6195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberSATC005
License Number StateNE

VIII. Authorized Official

Name: MR. CARROLL L. BARNES
Title or Position: DIRECTOR
Credential: LADAC
Phone: 308-382-0422