Provider Demographics
NPI:1124105192
Name:NISHNA PRODUCTIONS, INC.
Entity type:Organization
Organization Name:NISHNA PRODUCTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-623-4362
Mailing Address - Street 1:902 DAY ST
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-1106
Mailing Address - Country:US
Mailing Address - Phone:712-246-1242
Mailing Address - Fax:712-246-1243
Practice Address - Street 1:902 DAY ST
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:IA
Practice Address - Zip Code:51601-1106
Practice Address - Country:US
Practice Address - Phone:712-246-1242
Practice Address - Fax:712-246-1243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0893255Medicaid