Provider Demographics
NPI:1538547815
Name:CHI HEALTH IMMANUEL REHABILITATION INSTITUTE
Entity type:Organization
Organization Name:CHI HEALTH IMMANUEL REHABILITATION INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OD WELLNESS AND WEIGHT MGMT
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIRTHOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, CERT MDT
Authorized Official - Phone:402-213-5179
Mailing Address - Street 1:PIO BOX 642117
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7101 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2164
Practice Address - Country:US
Practice Address - Phone:402-572-2333
Practice Address - Fax:402-572-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111359261QH0100X
NE111062261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1356604193Medicare PIN
NE1932331824Medicare PIN