Healthcare Provider Details

I. General information

NPI: 1003621939
Provider Name (Legal Business Name): SEIFELDIN MOHAMED ELHASSAN ABDALLAH BSC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2025
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 W M CT
LINCOLN NE
68522-1006
US

IV. Provider business mailing address

5831 N 23RD ST APT 101
LINCOLN NE
68521-1094
US

V. Phone/Fax

Practice location:
  • Phone: 402-325-8555
  • Fax: 402-325-8575
Mailing address:
  • Phone: 402-610-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberH13240518
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License NumberH13240518
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: