Provider Demographics
NPI:1942240122
Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Entity Type:Organization
Organization Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Other - Org Name:LINCOLN REGIONAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:T
Authorized Official - Last Name:WINTERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-471-9433
Mailing Address - Street 1:WEST PROSPECTOR PLACE & FOLSOM STREET
Mailing Address - Street 2:PO BOX 94949
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68509-4949
Mailing Address - Country:US
Mailing Address - Phone:402-479-5419
Mailing Address - Fax:
Practice Address - Street 1:WEST PROSPECTOR PLACE & FOLSOM STREET
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68509-4949
Practice Address - Country:US
Practice Address - Phone:402-479-5419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEMHC008273R00000X
NE500004283Q00000X
NEMHC005323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No273R00000XHospital UnitsPsychiatric Unit
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE0647OtherBLUE CROSS/BLUE SHIELD
NE=========-06Medicaid
NE=========-25Medicaid
NE=========-41Medicaid
NE=========-30Medicaid
NE=========-06Medicaid