MEDICARE: CENTRAL NEBRASKA COMMUNITY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1538455084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL NEBRASKA COMMUNITY SERVICES, INC.

Provider Business Mailing Address
First Line	:	626 N STREET
Second Line	:	POB 509
City	:	LOUP CITY
State	:	NE
Zip	:	68853-0509
Country	:	US
Telephone Number	:	308-745-0780
Fax Number	:	308-745-0824

Provider Business Practice Location Address
First Line	:	626 N STREET
Second Line	:	POB 509
City	:	LOUP CITY
State	:	NE
Zip	:	68853-0509
Country	:	US
Telephone Number	:	308-745-0780
Fax Number	:	308-745-0824

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JOSE ZAPATA
Credential	:
Telephone Number	:	308-745-0780

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	06/23/2011

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