Provider Demographics
NPI:1295834281
Name:BOYS AND GIRLS HOME OF NEBRASKA, INC.
Entity Type:Organization
Organization Name:BOYS AND GIRLS HOME OF NEBRASKA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SHEEHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-293-4700
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-0127
Mailing Address - Country:US
Mailing Address - Phone:712-293-4700
Mailing Address - Fax:712-293-4800
Practice Address - Street 1:100 FUTURES DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3920
Practice Address - Country:US
Practice Address - Phone:712-293-4700
Practice Address - Fax:712-293-4800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========-27Medicaid
NE=========-30Medicaid
NE=========-33Medicaid
NE=========-43Medicaid
NE=========-35Medicaid
NE=========-42Medicaid
NE=========-44Medicaid
NE=========-45Medicaid
NE=========-26Medicaid