Provider Demographics
NPI:1851844971
Name:NEBRASKA PROVIDER ALLIANCE LLC
Entity Type:Organization
Organization Name:NEBRASKA PROVIDER ALLIANCE LLC
Other - Org Name:RURALMED HOME CARE RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRPERSON
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-995-2211
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-0470
Mailing Address - Country:US
Mailing Address - Phone:308-995-3313
Mailing Address - Fax:
Practice Address - Street 1:1600 W 13TH ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NE
Practice Address - Zip Code:68850-1196
Practice Address - Country:US
Practice Address - Phone:308-324-8300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEBRASKA PROVIDER ALLIANCE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-25
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHOSPICE 57251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE281533Medicare Oscar/Certification