Provider Demographics
NPI:1558717074
Name:WINNEBAGO TRIBE OF NEBRASKA
Entity Type:Organization
Organization Name:WINNEBAGO TRIBE OF NEBRASKA
Other - Org Name:YCIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPOINTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:402-878-2046
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:WINNEBAGO
Mailing Address - State:NE
Mailing Address - Zip Code:68071-0654
Mailing Address - Country:US
Mailing Address - Phone:402-878-2046
Mailing Address - Fax:402-878-2065
Practice Address - Street 1:AUGUSTINE DR. #2
Practice Address - Street 2:
Practice Address - City:WINNEBAGO
Practice Address - State:NE
Practice Address - Zip Code:68071
Practice Address - Country:US
Practice Address - Phone:402-878-2046
Practice Address - Fax:402-878-2065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026578500Medicaid