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NPI Code Detail

MEDICARE: ASSISTED GROWTH SERVICES OF NEBRASKA

MEDICARE: ASSISTED GROWTH SERVICES OF NEBRASKA
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
1320600000XIntellectual and/or Developmental Disabilities Residential Treatment FacilityNE

General Provider Information

NPI Number : 1548634017
Entity Type Code : Organization
Provider Name (Legal Business Name) : ASSISTED GROWTH SERVICES OF NEBRASKA
Provider Business Mailing Address
First Line : 10909 COTTONWOOD LN
Second Line :
City : OMAHA
State : NE
Zip : 68164-3715
Country : US
Telephone Number : 402-990-9874
Fax Number :
Provider Business Practice Location Address
First Line : 10909 COTTONWOOD LN
Second Line :
City : OMAHA
State : NE
Zip : 68164-3715
Country : US
Telephone Number : 402-990-9874
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : WATSON CHIPAKO
Credential :
Telephone Number : 402-990-9874
Provider Enumeration Date : 11/21/2015
Last Update Date : 11/21/2015

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Directions to “ASSISTED GROWTH SERVICES OF NEBRASKA ” Practice Location

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