Healthcare Provider Details

I. General information

NPI: 1942240122
Provider Name (Legal Business Name): STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WEST PROSPECTOR PLACE & FOLSOM STREET
LINCOLN NE
68509-4949
US

IV. Provider business mailing address

WEST PROSPECTOR PLACE & FOLSOM STREET PO BOX 94949
LINCOLN NE
68509-4949
US

V. Phone/Fax

Practice location:
  • Phone: 402-479-5419
  • Fax:
Mailing address:
  • Phone: 402-479-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberMHC008
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number500004
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberMHC005
License Number StateNE

VIII. Authorized Official

Name: KERRY T WINTERER
Title or Position: CEO
Credential:
Phone: 402-471-9433