1619140266 NPI number — CAROLINE JOY HADLAND OTD OTR L

Table of content: MRS. EVITA KING STANDARD CARE ALF (NPI 1508349838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619140266 NPI number — CAROLINE JOY HADLAND OTD OTR L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADLAND
Provider First Name:
CAROLINE
Provider Middle Name:
JOY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTD OTR L
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUBY
Provider Other First Name:
CAROLINE
Provider Other Middle Name:
JOY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTD OTR L
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619140266
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-483-9626
Provider Business Mailing Address Fax Number:
402-486-9098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5401 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68506-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-483-9626
Provider Business Practice Location Address Fax Number:
402-486-9098
Provider Enumeration Date:
04/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1335 , 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: 47043959902 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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