Healthcare Provider Details

I. General information

NPI: 1487391215
Provider Name (Legal Business Name): SILVER LAKE PUBLIC SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2022
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9405 S LINCOLN AVE
ROSELAND NE
68973-1842
US

IV. Provider business mailing address

PO BOX 8
ROSELAND NE
68973-0008
US

V. Phone/Fax

Practice location:
  • Phone: 402-460-7595
  • Fax:
Mailing address:
  • Phone: 402-756-6611
  • Fax: 402-207-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. TERENCE BAUER
Title or Position: SUPERINTENDENT
Credential:
Phone: 402-756-6611