Provider Demographics
NPI:1124617311
Name:BROADSTEP ACADEMY - NEBRASKA INC
Entity type:Organization
Organization Name:BROADSTEP ACADEMY - NEBRASKA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STATE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-543-5926
Mailing Address - Street 1:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:KINGSTREE
Mailing Address - State:SC
Mailing Address - Zip Code:29556-1037
Mailing Address - Country:US
Mailing Address - Phone:843-355-4664
Mailing Address - Fax:843-355-4672
Practice Address - Street 1:BROADSTEP ACADEMY - NEBRASKA INC
Practice Address - Street 2:5820 ELKCREST DR
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516
Practice Address - Country:US
Practice Address - Phone:414-240-5914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROADSTEP ACADEMY - NEBRASKA INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities