Provider Demographics
NPI:1063558864
Name:NEBCO ASSOCIATES, INC.
Entity type:Organization
Organization Name:NEBCO ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MACIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-561-5686
Mailing Address - Street 1:16 HAWK RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1861
Mailing Address - Country:US
Mailing Address - Phone:480-966-8377
Mailing Address - Fax:480-736-9000
Practice Address - Street 1:3401 E ELWOOD ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85040-1610
Practice Address - Country:US
Practice Address - Phone:602-296-6542
Practice Address - Fax:602-437-2594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ174314Medicaid