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General NPI Number Information
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NPI Number | 1891338661
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Entity Type | Organization
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Legal Business Name | MISSION FIELD LLC
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Dates
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Enumeration Date | 10/23/2019
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 1104 3RD AVE
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City | NEBRASKA CITY
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State | NE
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Zip | 68410-2011
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Country | US
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Telephone | 402-873-1130
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Fax |
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Provider Business Mailing Address
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Address Line | 1104 3RD AVE
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City | NEBRASKA CITY
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State | NE
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Zip | 68410-2011
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Country | US
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Telephone | 402-873-1130
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | EDWARD TUCKER
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Credential |
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Telephone | 561-685-2775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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