Provider Demographics
NPI:1013397819
Name:NEBRASKA PROVIDER ALLIANCE LLC
Entity Type:Organization
Organization Name:NEBRASKA PROVIDER ALLIANCE LLC
Other - Org Name:RURALMED HOME CARE RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-995-2211
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-0470
Mailing Address - Country:US
Mailing Address - Phone:308-995-3313
Mailing Address - Fax:
Practice Address - Street 1:507 WEST AVE
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-2226
Practice Address - Country:US
Practice Address - Phone:308-995-4375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEBRASKA PROVIDER ALLIANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-05
Last Update Date:2020-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHHA201503251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE287087Medicare Oscar/Certification