Basic Information
Provider Information
NPI: 1245478197
EntityType: 2
ReplacementNPI:  
OrganizationName: CATHOLIC CHARITIES OF THE ARCHDIOCESE OF OMAHA, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: JOURNEYS
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3300 N 60TH ST
Address2:  
City: OMAHA
State: NE
PostalCode: 681043402
CountryCode: US
TelephoneNumber: 4025540520
FaxNumber: 4025518797
Practice Location
Address1: 11111 M ST
Address2:  
City: OMAHA
State: NE
PostalCode: 681372378
CountryCode: US
TelephoneNumber: 4028984135
FaxNumber: 4025518797
Other Information
ProviderEnumerationDate: 01/30/2009
LastUpdateDate: 05/02/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ROSS
AuthorizedOfficialFirstName: THERESA
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: SENIOR FINANCE DIRECTOR
AuthorizedOfficialTelephone: 4028299292
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
3245S0500XSATC153NEY Residential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children

No ID Information.


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