Provider Demographics
NPI:1093041204
Name:BEHAVEN COMMUNITY SERVICES
Entity Type:Organization
Organization Name:BEHAVEN COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMHP
Authorized Official - Phone:402-423-6464
Mailing Address - Street 1:1145 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-4440
Mailing Address - Country:US
Mailing Address - Phone:402-423-6464
Mailing Address - Fax:402-423-6465
Practice Address - Street 1:1145 HIGH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-4440
Practice Address - Country:US
Practice Address - Phone:402-423-6464
Practice Address - Fax:402-423-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025632600Medicaid