Provider Demographics
NPI:1871962944
Name:CHARLES DREW HEALTH CENTER
Entity type:Organization
Organization Name:CHARLES DREW HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TARSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-457-1200
Mailing Address - Street 1:2915 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-3863
Mailing Address - Country:US
Mailing Address - Phone:402-453-1433
Mailing Address - Fax:402-457-1210
Practice Address - Street 1:2915 GRANT ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3863
Practice Address - Country:US
Practice Address - Phone:402-453-1433
Practice Address - Fax:402-457-1210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES DREW HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-18
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261QD0000X, 261QF0400X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)