Healthcare Provider Details

I. General information

NPI: 1841832870
Provider Name (Legal Business Name): SOUTH CENTRAL DEVELOPMENTAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 J ST
COZAD NE
69130-1708
US

IV. Provider business mailing address

PO BOX 367
COZAD NE
69130-0367
US

V. Phone/Fax

Practice location:
  • Phone: 308-784-4222
  • Fax: 308-784-4231
Mailing address:
  • Phone: 308-784-4222
  • Fax: 308-784-4231

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: LAURIE PREITAUER
Title or Position: AGENCY ADMINISTRATOR
Credential:
Phone: 308-784-4222