Healthcare Provider Details

I. General information

NPI: 1962758979
Provider Name (Legal Business Name): TR HEPBURN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 Q ST APT 101
LINCOLN NE
68503-3643
US

IV. Provider business mailing address

2039 Q ST APT 101
LINCOLN NE
68503-3643
US

V. Phone/Fax

Practice location:
  • Phone: 402-474-2121
  • Fax: 402-477-9752
Mailing address:
  • Phone: 402-474-2121
  • Fax: 402-477-9752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberALF116
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberALF181
License Number StateNE
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberB1750
License Number StateNE
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT FREDERICK HEPBURN
Title or Position: OFFICER/BUSINESS MANAGER
Credential:
Phone: 402-474-2121