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	101YM0800X	Mental Health Counselor	NE
2	261QC1500X	Community Health Clinic/Center	NH
3	261QC1500X	Community Health Clinic/Center	NE
4	363A00000X	Physician Assistant	NE
5	363LC1500X	Community Health Nurse Practitioner	NE
6	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

General Provider Information

NPI Number	:	1932493822
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	:	68103-1119
Country	:	US
Telephone Number	:	402-451-3553
Fax Number	:	402-457-1220

Provider Business Practice Location Address
First Line	:	1490 NORTH 16TH STREET
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102-4118
Country	:	US
Telephone Number	:	402-346-8401
Fax Number	:	402-453-2061

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MS. TARSHA DENISE JACKSON
Credential	:
Telephone Number	:	402-457-1215

Provider Enumeration Date	:	06/08/2011
Last Update Date	:	03/19/2021

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Directions to “CHARLES DREW HEALTH CENTER INC ” Practice Location

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