Provider Demographics
| NPI: | 1306919881 |
|---|---|
| Name: | FIRST STEP RECOVERY CENTER INC. |
| Entity type: | Organization |
| Organization Name: | FIRST STEP RECOVERY CENTER INC. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | DIRECTOR/OPERATIONS COORDINATOR |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | JARED |
| Authorized Official - Middle Name: | W |
| Authorized Official - Last Name: | RAY |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MA |
| Authorized Official - Phone: | 402-434-2730 |
| Mailing Address - Street 1: | 300 S 68TH STREET PL |
| Mailing Address - Street 2: | SUITE 500 |
| Mailing Address - City: | LINCOLN |
| Mailing Address - State: | NE |
| Mailing Address - Zip Code: | 68510-2475 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 402-434-2730 |
| Mailing Address - Fax: | 402-434-3970 |
| Practice Address - Street 1: | 300 S 68TH STREET PL |
| Practice Address - Street 2: | SUITE 500 |
| Practice Address - City: | LINCOLN |
| Practice Address - State: | NE |
| Practice Address - Zip Code: | 68510-2475 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 402-434-2730 |
| Practice Address - Fax: | 402-434-3970 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-11-15 |
| Last Update Date: | 2016-08-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NE | SATC221 | 261QM0801X, 261QR0405X, 261QM0855X, 261QM0850X, 101YA0400X, 101YM0800X, 103TC0700X, 207QA0401X, 261QM1300X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Multi-Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Multi-Specialty |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | Group - Multi-Specialty |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | Group - Multi-Specialty |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 207QA0401X | Allopathic & Osteopathic Physicians | Family Medicine | Addiction Medicine | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NE | 10025734000 | Other | NE MEDICAID ADULT SA PROVIDER ID |
| NE | 2819196 | Other | NCPDP NPDS # |
| NE | 9094585 | Other | AETNA FACILITY ID |
| NE | 129619 | Other | VALUE OPTIONS FACILITY ID |
| NE | 098935 | Other | MEDICARE PTAN |
| NE | 10026038300 | Other | NE MEDICAID ADOLESCENT IOP PROVIDER ID |
| NE | 28D2077900 | Other | CLIA WAIVER CERT. |
| NE | 994768 | Other | COVENTRY FACILITY ID |
| NE | 99036 | Other | BCBS FACILITY MH |
| NE | 10026038302 | Other | NE MEDICAID DP PHARMACY PROVIDER ID |
| NE | CJ5965 | Other | MEDICARE RR UPIN |
| NE | FAC001060700 | Other | OPTUM FACILITY ID |
| NE | 99037 | Other | BCBS FACILITY SA |
| NE | 10026038301 | Other | NE MEDICAID MEDICAL PROVIDER ID |
| NE | 129619 | Other | VALUE OPTIONS FACILITY ID |
| NE | 2819196 | Other | NCPDP NPDS # |
