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General NPI Number Information
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NPI Number | 1639615198
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Entity Type | Organization
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Legal Business Name | THE LINK DUAL RECOVERY PROGRAM
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 305 N 9TH ST
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City | NORFOLK
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State | NE
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Zip | 68701-3915
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Country | US
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Telephone | 402-999-4771
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Fax | 402-370-9810
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Provider Business Mailing Address
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Address Line | 305 N 9TH ST
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City | NORFOLK
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State | NE
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Zip | 68701-3915
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Country | US
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Telephone | 402-999-4771
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Fax | 402-370-9810
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. TOM R BARR
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Credential | LMHP, LADC
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Telephone | 402-371-5310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 252
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License Number State | NE
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