Basic Information
| Provider Information | |||||||||
| NPI: | 1285739615 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAITH REGIONAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 869 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687020869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026447144 | ||||||||
| FaxNumber: | 4026447432 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 KOENIGSTEIN AVE | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | NE | ||||||||
| PostalCode: | 687013664 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026447439 | ||||||||
| FaxNumber: | 4026447432 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2006 | ||||||||
| LastUpdateDate: | 01/04/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SINEK | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CEO | ||||||||
| AuthorizedOfficialTelephone: | 4026447468 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FAITH REGIONAL HEALTH SERVICES | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | LTCH025 | NE | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00520 | 01 | NE | BCBS SNF | OTHER | 5000020 | 01 | NE | UNITED HEALTHCARE SNF | OTHER | 0006400415 | 01 | NE | AETNA TCU | OTHER |