Healthcare Provider Details

I. General information

NPI: 1295834281
Provider Name (Legal Business Name): BOYS AND GIRLS HOME OF NEBRASKA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FUTURES DR
SOUTH SIOUX CITY NE
68776-3920
US

IV. Provider business mailing address

PO BOX 127
SOUTH SIOUX CITY NE
68776-0127
US

V. Phone/Fax

Practice location:
  • Phone: 712-293-4700
  • Fax: 712-293-4800
Mailing address:
  • Phone: 712-293-4700
  • Fax: 712-293-4800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ROBERT P SHEEHAN
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 712-293-4700