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General NPI Number Information
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NPI Number | 1962758979
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Entity Type | Organization
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Legal Business Name | TR HEPBURN INC
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Dates
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Enumeration Date | 07/27/2012
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Last Update Date | 05/21/2015
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Provider Practice Location Address
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Address Line | 2039 Q ST APT 101
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City | LINCOLN
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State | NE
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Zip | 68503-3643
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Country | US
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Telephone | 402-474-2121
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Fax | 402-477-9752
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Provider Business Mailing Address
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Address Line | 2039 Q ST APT 101
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City | LINCOLN
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State | NE
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Zip | 68503-3643
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Country | US
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Telephone | 402-474-2121
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Fax | 402-477-9752
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Authorized Official
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Title or Position | OFFICER/BUSINESS MANAGER
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Name | MR. ROBERT FREDERICK HEPBURN
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Credential |
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Telephone | 402-474-2121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | ALF181
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | B1750
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number | ALF116
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License Number State | NE
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