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General NPI Number Information
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NPI Number | 1699548164
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Entity Type | Organization
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Legal Business Name | PRIORITY FOSTER CARE
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 2612 BRYAN AVE
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City | BELLEVUE
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State | NE
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Zip | 68005-2865
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Country | US
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Telephone | 402-850-4577
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Fax |
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Provider Business Mailing Address
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Address Line | 2612 BRYAN AVE
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City | BELLEVUE
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State | NE
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Zip | 68005-2865
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Country | US
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Telephone | 140-285-0457
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SHAWN ADAM RIDDLE
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Credential |
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Telephone | 402-850-4577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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