1306919881 NPI number — FIRST STEP RECOVERY CENTER INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306919881 NPI number — FIRST STEP RECOVERY CENTER INC.

Employer Identification Number (EIN):

Provider Organization Name:

FIRST STEP RECOVERY CENTER 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 Other Organization Name:

FIRST STEP

Provider Other Organization Name Type Code:

3

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:

1306919881

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

08/04/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

300 S 68TH STREET PL

Provider Second Line Business Mailing Address:

SUITE 500

Provider Business Mailing Address City Name:

LINCOLN

Provider Business Mailing Address State Name:

NE

Provider Business Mailing Address Postal Code:

68510-2475

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

402-434-2730

Provider Business Mailing Address Fax Number:

402-434-3970

Provider First Line Business Practice Location Address:

300 S 68TH STREET PL

Provider Second Line Business Practice Location Address:

SUITE 500

Provider Business Practice Location Address City Name:

LINCOLN

Provider Business Practice Location Address State Name:

NE

Provider Business Practice Location Address Postal Code:

68510-2475

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

402-434-2730

Provider Business Practice Location Address Fax Number:

402-434-3970

Provider Enumeration Date:

11/15/2006

Authorized Official Last Name:

RAY

Authorized Official First Name:

JARED

Authorized Official Middle Name:

W

Authorized Official Title or Position:

DIRECTOR/OPERATIONS COORDINATOR

Authorized Official Telephone Number:

402-434-2730

• Taxonomy code: 101YA0400X , with the licence number:  SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 101YM0800X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TC0700X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207QA0401X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM0801X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM0850X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM0855X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 261QM1300X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 261QR0405X , with the licence number: SATC221 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 10025734000 . This is a "NE MEDICAID ADULT SA PROVIDER ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 2819196 . This is a "NCPDP NPDS #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 9094585 . This is a "AETNA FACILITY ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 129619 . This is a "VALUE OPTIONS FACILITY ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 098935 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 10026038300 . This is a "NE MEDICAID ADOLESCENT IOP PROVIDER ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 28D2077900 . This is a "CLIA WAIVER CERT." identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 994768 . This is a "COVENTRY FACILITY ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 99036 . This is a "BCBS FACILITY MH" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 10026038302 . This is a "NE MEDICAID DP PHARMACY PROVIDER ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: CJ5965 . This is a "MEDICARE RR UPIN" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: FAC001060700 . This is a "OPTUM FACILITY ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 99037 . This is a "BCBS FACILITY SA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
• Identifier: 10026038301 . This is a "NE MEDICAID MEDICAL PROVIDER ID" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".