Provider Demographics
NPI:1982973913
Name:BEATRICE STATE DEVELOPMENTAL CENTER
Entity Type:Organization
Organization Name:BEATRICE STATE DEVELOPMENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-806-8349
Mailing Address - Street 1:3000 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310-3319
Mailing Address - Country:US
Mailing Address - Phone:402-223-6600
Mailing Address - Fax:
Practice Address - Street 1:3000 LINCOLN BLVD
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310-3319
Practice Address - Country:US
Practice Address - Phone:402-223-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE232320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities