Healthcare Provider Details

I. General information

NPI: 1326952326
Provider Name (Legal Business Name): MR. MARK LYNN LUBER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86994 493 AVE
O'NEILL NE
68763
US

IV. Provider business mailing address

86994 493 AVE
O'NEILL NE
68763
US

V. Phone/Fax

Practice location:
  • Phone: 402-340-4770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: