Provider Demographics
NPI:1073941100
Name:ABBA LIGHTED PATH RECOVERY SERVICES
Entity Type:Organization
Organization Name:ABBA LIGHTED PATH RECOVERY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:REMINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LADC
Authorized Official - Phone:402-641-6245
Mailing Address - Street 1:147 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2003
Mailing Address - Country:US
Mailing Address - Phone:402-641-6245
Mailing Address - Fax:402-646-2045
Practice Address - Street 1:905 MAIN ST
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2047
Practice Address - Country:US
Practice Address - Phone:402-641-6245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder