Healthcare Provider Details

I. General information

NPI: 1265709745
Provider Name (Legal Business Name): BEATRICE STATE DEVELOPMENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LINCOLN BLVD
BEATRICE NE
68310-3319
US

IV. Provider business mailing address

3000 LINCOLN BLVD
BEATRICE NE
68310-3319
US

V. Phone/Fax

Practice location:
  • Phone: 402-223-6600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number964
License Number StateNE

VIII. Authorized Official

Name: MR. ANDREW ASHELFORD
Title or Position: DIETITIAN
Credential: RD, LMNT
Phone: 402-806-2681