Basic Information
| Provider Information | |||||||||
| NPI: | 1417013350 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOOD NEIGHBOR COMMUNITY HEALTH CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GOOD NEIGHBOR COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2282 E 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686017233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025639224 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Practice Location | |||||||||
| Address1: | 2282 E 32ND AVE | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | NE | ||||||||
| PostalCode: | 686017233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025639224 | ||||||||
| FaxNumber: | 4025640611 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 07/16/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RAYMANN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4025639224 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | HCO36 | NE | Y | Agencies | Public Health or Welfare |
ID Information
| ID | Type | State | Issuer | Description | ----5076100 | 05 | NE | MEDICAID | ----4980200 | 05 | NE | MEDICAID |