=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184519522
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMSTOCK DEN INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 123 W MAIN
-----------------------------------------------------
City | COMSTOCK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68828-4518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-628-4235
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 25
-----------------------------------------------------
City | COMSTOCK
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68828-0025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CAROL ERICKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-628-4235
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------