Provider Demographics
NPI:1023673282
Name:CHARLES DREW HEALTH CENTER, INC.
Entity type:Organization
Organization Name:CHARLES DREW HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHEIF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:STRINGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-457-1215
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:402-451-3553
Mailing Address - Fax:402-457-1220
Practice Address - Street 1:2120 N 30TH ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-3701
Practice Address - Country:US
Practice Address - Phone:402-455-2229
Practice Address - Fax:402-939-0114
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES DREW HEALTH CENTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026276410Medicaid
NE10026276411OtherMEDICAID-NON FQHC