=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811623028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF LINCOLN SCHOOL DISTRICT 55
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2022
-----------------------------------------------------
Last Update Date | 07/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 WALNUT ST
-----------------------------------------------------
City | SUTHERLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69165-7257
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-386-4656
-----------------------------------------------------
Fax | 308-386-2426
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 217
-----------------------------------------------------
City | SUTHERLAND
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 69165-0217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-386-4656
-----------------------------------------------------
Fax | 308-386-2426
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | MRS. ALISHA J MORGAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 308-386-4656
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------