Provider Demographics
NPI:1912276585
Name:PACE NEBRAKSA
Entity Type:Organization
Organization Name:PACE NEBRAKSA
Other - Org Name:IMMANUEL PATHWAYS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OF HOME & COMMUNITY OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:NYQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-829-3204
Mailing Address - Street 1:1044 N 115TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4425
Mailing Address - Country:US
Mailing Address - Phone:402-829-2900
Mailing Address - Fax:402-829-2939
Practice Address - Street 1:6757 NEWPORT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2262
Practice Address - Country:US
Practice Address - Phone:402-829-2900
Practice Address - Fax:402-829-2939
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IMMANUEL HOME AND COMMUNITY RESOURCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-27
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization