Provider Demographics
NPI:1881605566
Name:NEBRASKA LONG TERM CARE, LLC
Entity type:Organization
Organization Name:NEBRASKA LONG TERM CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:DEINES
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH
Authorized Official - Phone:402-223-4779
Mailing Address - Street 1:910 COURT ST STE D
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-4085
Mailing Address - Country:US
Mailing Address - Phone:402-223-4779
Mailing Address - Fax:402-223-0153
Practice Address - Street 1:910 COURT ST STE D
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-4085
Practice Address - Country:US
Practice Address - Phone:402-223-4779
Practice Address - Fax:402-223-0153
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEINES PHARMACY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-10
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10088183500000X
3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025162800Medicaid
2816885OtherNCPDP