1184627911 NPI number — CENTRAL NEBRASKA REHABILITATION SERVICES LLC

Table of content: (NPI 1184627911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184627911 NPI number — CENTRAL NEBRASKA REHABILITATION SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL NEBRASKA REHABILITATION SERVICES 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:
1184627911
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5285
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND ISLAND
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68802-5285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
308-382-0344
Provider Business Mailing Address Fax Number:
308-382-3241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 N DIERS AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
GRAND ISLAND
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68803-4985
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
308-382-0344
Provider Business Practice Location Address Fax Number:
308-382-3241
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECKSTEAD
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
308-382-0344

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  681 , 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: NA2070 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100250456-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com