Provider Demographics
NPI:1568851400
Name:DEVELOPMENTAL DISABILITY CENTER OF NEBRASKA
Entity Type:Organization
Organization Name:DEVELOPMENTAL DISABILITY CENTER OF NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RACHIDI
Authorized Official - Middle Name:FRAISE
Authorized Official - Last Name:ADEDOKOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-686-6974
Mailing Address - Street 1:4017 GREENE AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1819
Mailing Address - Country:US
Mailing Address - Phone:402-686-6974
Mailing Address - Fax:
Practice Address - Street 1:4017 GREENE AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68147-1819
Practice Address - Country:US
Practice Address - Phone:402-686-6974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness