Provider Demographics
NPI:1306919881
Name:FIRST STEP RECOVERY CENTER INC.
Entity type:Organization
Organization Name:FIRST STEP RECOVERY CENTER INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OPERATIONS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:W
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:402-434-2730
Mailing Address - Street 1:300 S 68TH STREET PL
Mailing Address - Street 2:SUITE 500
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2475
Mailing Address - Country:US
Mailing Address - Phone:402-434-2730
Mailing Address - Fax:402-434-3970
Practice Address - Street 1:300 S 68TH STREET PL
Practice Address - Street 2:SUITE 500
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2475
Practice Address - Country:US
Practice Address - Phone:402-434-2730
Practice Address - Fax:402-434-3970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NESATC221261QM0801X, 261QR0405X, 261QM0855X, 261QM0850X, 101YA0400X, 101YM0800X, 103TC0700X, 207QA0401X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025734000OtherNE MEDICAID ADULT SA PROVIDER ID
NE2819196OtherNCPDP NPDS #
NE9094585OtherAETNA FACILITY ID
NE129619OtherVALUE OPTIONS FACILITY ID
NE098935OtherMEDICARE PTAN
NE10026038300OtherNE MEDICAID ADOLESCENT IOP PROVIDER ID
NE28D2077900OtherCLIA WAIVER CERT.
NE994768OtherCOVENTRY FACILITY ID
NE99036OtherBCBS FACILITY MH
NE10026038302OtherNE MEDICAID DP PHARMACY PROVIDER ID
NECJ5965OtherMEDICARE RR UPIN
NEFAC001060700OtherOPTUM FACILITY ID
NE99037OtherBCBS FACILITY SA
NE10026038301OtherNE MEDICAID MEDICAL PROVIDER ID
NE129619OtherVALUE OPTIONS FACILITY ID
NE2819196OtherNCPDP NPDS #