MEDICARE: CHARLES DREW HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	261QC1500X	Community Health Clinic/Center
2	101Y00000X	Counselor
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	101YM0800X	Mental Health Counselor
5	103T00000X	Psychologist
6	363LC1500X	Community Health Nurse Practitioner
7	363LC1500X	Community Health Nurse Practitioner	NE
8	261QF0400X	Federally Qualified Health Center (FQHC)	NE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346597895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHARLES DREW HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	PO BOX 30019
Second Line	:	2915 GRANT STREET
City	:	OMAHA
State	:	NE
Zip	:	68111-3863
Country	:	US
Telephone Number	:	402-451-3553
Fax Number	:	402-457-1220

Provider Business Practice Location Address
First Line	:	5904 HENNIGER AVENUE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68183-0001
Country	:	US
Telephone Number	:	402-457-1240
Fax Number	:	402-453-1970

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. ANDRE STRINGFELLOW
Credential	:
Telephone Number	:	402-457-1215

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	07/11/2024

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