Provider Demographics
NPI:1114085826
Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Entity Type:Organization
Organization Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Other - Org Name:BEATRICE STATE DEVELOPMENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACILITY ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-223-6600
Mailing Address - Street 1:3000 LINCOLN
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3319
Mailing Address - Country:US
Mailing Address - Phone:402-223-6600
Mailing Address - Fax:402-223-7589
Practice Address - Street 1:3000 LINCOLN
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3319
Practice Address - Country:US
Practice Address - Phone:402-223-6600
Practice Address - Fax:402-223-7589
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEBRASKA DEPT OF ADMIN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X, 261QP0905X, 315P00000X
NE098247BE261QH0100X
NE320003282N00000X
NEICFMR03320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No282N00000XHospitalsGeneral Acute Care Hospital
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE280123Medicare Oscar/Certification
NE098247Medicare PIN
NE280123Medicare Oscar/Certification