MEDICARE: FAMILY DEVELOPMENT SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251J00000X	Nursing Care Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033885777
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DEVELOPMENT SERVICES LLC

Provider Business Mailing Address
First Line	:	4611 S 96TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1202
Country	:	US
Telephone Number	:	402-880-1484
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 S 96TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1202
Country	:	US
Telephone Number	:	402-880-1484
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	DR. BRIAN RAHAMAN
Credential	:
Telephone Number	:	402-880-1484

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	08/23/2021

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