Basic Information
| Provider Information | |||||||||
| NPI: | 1649369075 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CATHOLIC CHARITIES OF THE ARCHDIOCESE OF OMAHA INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | OMAHA CAMPUS FOR HOPE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 N 60TH ST | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681043402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4025540520 | ||||||||
| FaxNumber: | 4025518797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1490 N 16TH ST. | ||||||||
| Address2: | OMAHA CAMPUS FOR HOPE | ||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681024101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4028270570 | ||||||||
| FaxNumber: | 4028270580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| AuthorizedOfficialLastName: | ROSS | ||||||||
| AuthorizedOfficialFirstName: | THERESA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR FINANCE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4028299292 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 324500000X | SATC043 | NE | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
ID Information
| ID | Type | State | Issuer | Description | 99050 | 01 | NE | BCBS | OTHER | 10025315800 | 05 | NE | MEDICAID | 10025347600 | 05 | NE | MEDICAID | 47037561286 | 05 | NE | MEDICAID |