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General NPI Number Information
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NPI Number | 1790320604
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Entity Type | Organization
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Legal Business Name | CHAMPION HOMES OF HASTINGS LLC
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 602 S WABASH AVE
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City | HASTINGS
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State | NE
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Zip | 68901-6152
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Country | US
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Telephone | 402-303-0158
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1197
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City | HASTINGS
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State | NE
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Zip | 68902-1197
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Country | US
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Telephone | 402-469-1234
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GARY D. BARRERA
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Credential |
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Telephone | 402-469-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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