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General NPI Number Information
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NPI Number | 1417397084
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Entity Type | Organization
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Legal Business Name | GUIDANCE TO SUCCESS YOUTH CLUB
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Dates
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Enumeration Date | 06/27/2013
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 6500 HOLDREGE ST
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City | LINCOLN
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State | NE
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Zip | 68505-1673
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Country | US
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Telephone | 402-464-1661
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Fax | 402-325-0212
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Provider Business Mailing Address
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Address Line | 6500 HOLDREGE ST
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City | LINCOLN
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State | NE
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Zip | 68505-1673
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Country | US
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Telephone | 402-464-1661
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Fax | 402-325-0212
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ANGELO CHILLS STABLER
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Credential |
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Telephone | 402-805-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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