Provider Demographics
NPI:1013004787
Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Entity Type:Organization
Organization Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Other - Org Name:NORFOLK REGIONAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-370-3400
Mailing Address - Street 1:1700 N VICTORY RD
Mailing Address - Street 2:P.O. BOX 1209
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-6859
Mailing Address - Country:US
Mailing Address - Phone:402-370-3400
Mailing Address - Fax:
Practice Address - Street 1:1700 N VICTORY RD
Practice Address - Street 2:BOX 1209
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-6859
Practice Address - Country:US
Practice Address - Phone:402-370-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE520003283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
00142OtherBC/BS OF NEBRASKA
284004Medicare ID - Type Unspecified
098069Medicare ID - Type UnspecifiedPART B