Healthcare Provider Details

I. General information

NPI: 1073473674
Provider Name (Legal Business Name): ANDRIA BEAURIVAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDIE BEAURIVAGE

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2721 S 39TH ST
LINCOLN NE
68506-3235
US

IV. Provider business mailing address

2721 S 39TH ST
LINCOLN NE
68506-3235
US

V. Phone/Fax

Practice location:
  • Phone: 402-525-7381
  • Fax:
Mailing address:
  • Phone: 402-525-7381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: