=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891164513
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE CORPS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2015
-----------------------------------------------------
Last Update Date | 09/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 723 N BROAD ST
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-4903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-721-3125
-----------------------------------------------------
Fax | 402-721-6246
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 723 N BROAD ST
-----------------------------------------------------
City | FREMONT
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68025-4903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-721-3125
-----------------------------------------------------
Fax | 402-721-6246
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. MICHAEL THOMAS WEHLING
-----------------------------------------------------
Credential | MPA
-----------------------------------------------------
Telephone | 402-721-3125
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------