Provider Demographics
NPI:1376104273
Name:BARRERA, GARY D (CEO)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:D
Last Name:BARRERA
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1197
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68902-1197
Mailing Address - Country:US
Mailing Address - Phone:402-469-1234
Mailing Address - Fax:402-303-6452
Practice Address - Street 1:602 S WABASH AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6152
Practice Address - Country:US
Practice Address - Phone:402-463-6021
Practice Address - Fax:402-463-7011
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF2183104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness