1043400807 NPI number — DEVELOPMENTAL SERVICES OF NEBRASKA, INC.

Table of content: (NPI 1043400807)

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

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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