Provider Demographics
NPI:1447622923
Name:FATHER FLANAGAN'S BOYS HOME
Entity type:Organization
Organization Name:FATHER FLANAGAN'S BOYS HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP DIRECTOR YOUTH CARE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:DALY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-498-3362
Mailing Address - Street 1:5074 AMES AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-2323
Mailing Address - Country:US
Mailing Address - Phone:402-498-3358
Mailing Address - Fax:402-498-3375
Practice Address - Street 1:5074 AMES AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-2323
Practice Address - Country:US
Practice Address - Phone:402-498-3358
Practice Address - Fax:402-498-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-23
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026370000Medicaid
NE10026330000Medicaid
NE=========24Medicaid