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General NPI Number Information
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NPI Number | 1558717074
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Entity Type | Organization
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Legal Business Name | WINNEBAGO TRIBE OF NEBRASKA
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Dates
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Enumeration Date | 05/13/2016
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Last Update Date | 05/02/2018
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Provider Practice Location Address
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Address Line | AUGUSTINE DR. #2
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City | WINNEBAGO
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State | NE
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Zip | 68071
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Country | US
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Telephone | 402-878-2046
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Fax | 402-878-2065
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Provider Business Mailing Address
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Address Line | PO BOX 654
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City | WINNEBAGO
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State | NE
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Zip | 68071-0654
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Country | US
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Telephone | 402-878-2046
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Fax | 402-878-2065
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. DARYL LAPOINTE JR.
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Credential |
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Telephone | 402-878-2046
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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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