Provider Demographics
NPI:1184627911
Name:CENTRAL NEBRASKA REHABILITATION SERVICES LLC
Entity Type:Organization
Organization Name:CENTRAL NEBRASKA REHABILITATION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKSTEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-382-0344
Mailing Address - Street 1:PO BOX 5285
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68802-5285
Mailing Address - Country:US
Mailing Address - Phone:308-382-0344
Mailing Address - Fax:308-382-3241
Practice Address - Street 1:620 N DIERS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4985
Practice Address - Country:US
Practice Address - Phone:308-382-0344
Practice Address - Fax:308-382-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA2070OtherMEDICARE PTAN
NE100250456-00Medicaid