=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578740502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FATHER FLANAGANS BOYS HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2008
-----------------------------------------------------
Last Update Date | 06/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14080 HOSPITAL RD
-----------------------------------------------------
City | BOYS TOWN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-778-6063
-----------------------------------------------------
Fax | 402-778-6062
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14080 BOYS TOWN HOSPITAL RD
-----------------------------------------------------
City | BOYS TOWN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68010-7513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-778-6063
-----------------------------------------------------
Fax | 402-778-6062
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR OF PHCY
-----------------------------------------------------
Name | DAVID SONGSTER
-----------------------------------------------------
Credential | PHRMD
-----------------------------------------------------
Telephone | 402-498-6355
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336M0003X
-----------------------------------------------------
Taxonomy Name | Managed Care Organization Pharmacy
-----------------------------------------------------
License Number | 2795
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------