1881072445 NPI number — MIDWEST ENCOURAGEMENT & COUNSELING CENTER LLC

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 1881072445 NPI number — MIDWEST ENCOURAGEMENT & COUNSELING CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST ENCOURAGEMENT & COUNSELING CENTER LLC
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:
Provider Other Organization Name Type Code:
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:
1881072445
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P. O. BOX 1686
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
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-224-0596
Provider Business Mailing Address Fax Number:
308-237-5225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 W. 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KEARNEY
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68845-6763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-224-0596
Provider Business Practice Location Address Fax Number:
308-237-5225
Provider Enumeration Date:
05/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ANGEL-TREJO
Authorized Official First Name:
JODY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
308-236-0500

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  4168 , 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: 10026307400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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