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General NPI Number Information
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NPI Number | 1568997179
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Entity Type | Organization
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Legal Business Name | AMERISERVE INTERNATIONAL OF NEBRASKA, INC.
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 35 MAIN PL STE 300
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0702
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Country | US
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Telephone | 712-322-0272
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Fax | 712-322-1411
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Provider Business Mailing Address
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Address Line | 35 MAIN PL STE 300
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City | COUNCIL BLUFFS
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State | IA
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Zip | 51503-0702
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Country | US
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Telephone | 712-322-0272
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Fax | 712-322-1411
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE / TREASURER
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Name | STEVEN B PEARSON
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Credential | CPA
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Telephone | 712-322-0272
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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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