Provider Demographics
NPI:1881791085
Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Entity type:Organization
Organization Name:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VETERANS HOME ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILGERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-471-7762
Mailing Address - Street 1:301 CENTENNIAL MALL S
Mailing Address - Street 2:PO BOX 98936
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68508-2529
Mailing Address - Country:US
Mailing Address - Phone:402-471-9447
Mailing Address - Fax:402-471-7783
Practice Address - Street 1:1102 W 42ND ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4711
Practice Address - Country:US
Practice Address - Phone:308-632-0324
Practice Address - Fax:308-632-1384
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STATE OF NEBRASKA DEPT OF ADMIN SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEALF192310400000X
NE704006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096376Medicare ID - Type UnspecifiedMEDICARE PART B PROVIDER