Provider Demographics
NPI:1063253714
Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Entity type:Organization
Organization Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH CARE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PUTNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-479-5630
Mailing Address - Street 1:3218 W VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68522-9278
Mailing Address - Country:US
Mailing Address - Phone:402-479-6331
Mailing Address - Fax:402-479-6100
Practice Address - Street 1:3218 W VAN DORN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68522-9278
Practice Address - Country:US
Practice Address - Phone:402-479-6331
Practice Address - Fax:402-479-6100
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service