Healthcare Provider Details

I. General information

NPI: 1689564304
Provider Name (Legal Business Name): MR. STEVEN AUSTIN RUGG
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 GRENOBLE DR
BELLEVUE NE
68123-4129
US

IV. Provider business mailing address

3601 FOX RIDGE DR
BELLEVUE NE
68123-3732
US

V. Phone/Fax

Practice location:
  • Phone: 210-842-7458
  • Fax:
Mailing address:
  • Phone: 402-215-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: