1043400807 NPI number — DEVELOPMENTAL SERVICES OF NEBRASKA, 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 1043400807 NPI number — DEVELOPMENTAL SERVICES OF NEBRASKA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENTAL SERVICES OF NEBRASKA, 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:
Provider Other Organization Name Type Code:
6
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:
1043400807
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5701 THOMPSON CREEK BLVD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68516-5686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-435-2800
Provider Business Mailing Address Fax Number:
402-435-8801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2610 W M CT
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:
68522-1006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-325-8555
Provider Business Practice Location Address Fax Number:
402-325-8575
Provider Enumeration Date:
07/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STORTENBECKER
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF DEVELOPMENT OFFICER
Authorized Official Telephone Number:
402-435-2134

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100251801-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100251107-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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