Provider Demographics
NPI:1962758979
Name:TR HEPBURN INC
Entity type:Organization
Organization Name:TR HEPBURN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:HEPBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-474-2121
Mailing Address - Street 1:2039 Q ST
Mailing Address - Street 2:APT 101
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3643
Mailing Address - Country:US
Mailing Address - Phone:402-474-2121
Mailing Address - Fax:402-477-9752
Practice Address - Street 1:2039 Q ST
Practice Address - Street 2:APT 101
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3643
Practice Address - Country:US
Practice Address - Phone:402-474-2121
Practice Address - Fax:402-477-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X, 390200000X
NEALF1163104A0625X
NEALF1813104A0625X
NEB1750343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026195600Medicaid
NE10026240800Medicaid
NE10026350200Medicaid
NE10026240900Medicaid
NE10025513400Medicaid
NE10026241000Medicaid
NE10026349800Medicaid
NE10026359400Medicaid