1225120413 NPI number — CENTRAL NEBRASKA LIFE SKILLS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225120413 NPI number — CENTRAL NEBRASKA LIFE SKILLS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL NEBRASKA LIFE SKILLS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY LIFE SKILLS COUNSELING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225120413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2292
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEARNEY
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68848-2292
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-234-8403
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2315 W 39TH ST
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68845-8327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-234-8403
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARLINGTON
Authorized Official First Name:
F.
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
CHAIRPERSON
Authorized Official Telephone Number:
308-234-8403

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  1839 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 85068 . This is a "BLUE CROSS AND BLUE SHIEL" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 573565271 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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