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General NPI Number Information
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NPI Number | 1962427781
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Entity Type | Organization
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Legal Business Name | EPWORTH VILLAGE, INC.
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 2119 N DIVISION AVE
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City | YORK
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State | NE
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Zip | 68467-1009
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Country | US
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Telephone | 402-362-3353
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 503 2119 DIVISION AVE.
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City | YORK
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State | NE
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Zip | 68467-0503
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Country | US
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Telephone | 402-362-3353
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | MR. THOMAS G. MCBRIDE
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Credential |
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Telephone | 402-362-3353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number | 79772233
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License Number State | NE
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