Healthcare Provider Details

I. General information

NPI: 1467258335
Provider Name (Legal Business Name): SETH WAYNE HEINEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 NORMAL BLVD
LINCOLN NE
68506-6828
US

IV. Provider business mailing address

6800 NORMAL BLVD
LINCOLN NE
68506-6828
US

V. Phone/Fax

Practice location:
  • Phone: 308-383-5203
  • Fax:
Mailing address:
  • Phone:
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: