1336561323 NPI number — MADONNA REHABILITATION SYSTEMS

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 1336561323 NPI number — MADONNA REHABILITATION SYSTEMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADONNA REHABILITATION SYSTEMS
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:
1336561323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5401 SOUTH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68506-2150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-413-4222
Provider Business Mailing Address Fax Number:
402-413-4113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 BELLEVUE MEDICAL CENTER DR
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68123-1591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-884-0006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
WITKOWICZ
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT & CFO
Authorized Official Telephone Number:
402-413-4222

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  H000125 , 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)





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