Provider Demographics
NPI:1215981493
Name:STATE OF NEBRASKA DEPT. OF ADM. SVCS
Entity type:Organization
Organization Name:STATE OF NEBRASKA DEPT. OF ADM. SVCS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-462-1971
Mailing Address - Street 1:4200 W 2ND ST
Mailing Address - Street 2:PO BOX 579
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-9700
Mailing Address - Country:US
Mailing Address - Phone:402-460-3116
Mailing Address - Fax:402-460-3133
Practice Address - Street 1:4200 W 2ND ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-9700
Practice Address - Country:US
Practice Address - Phone:402-460-3116
Practice Address - Fax:402-460-3133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE010001283Q00000X
NEMHC003323P00000X
NESATC009324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered283Q00000XHospitalsPsychiatric Hospital
Not Answered323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Not Answered324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251050 00Medicaid
=========OtherBCBS
NE========= 37Medicaid
NE========= 16Medicaid
=========OtherBCBS
098015Medicare ID - Type Unspecified