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General NPI Number Information
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NPI Number | 1487986600
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Entity Type | Organization
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Legal Business Name | LIGHTED PATH RECOVERY SERVICES
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Dates
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Enumeration Date | 02/13/2010
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Last Update Date | 02/06/2011
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Provider Practice Location Address
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Address Line | 905 MAIN ST
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City | SEWARD
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State | NE
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Zip | 68434-2047
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Country | US
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Telephone | 402-641-6245
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Fax | 402-646-2045
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Provider Business Mailing Address
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Address Line | 147 S 6TH ST
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City | SEWARD
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State | NE
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Zip | 68434-2003
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Country | US
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Telephone | 402-641-6245
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Fax | 402-643-6245
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MS. AMY KATHERYN ANDERSON
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Credential | PLADC
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Telephone | 402-641-6245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | P-824
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License Number State | NE
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