Basic Information
| Provider Information | |||||||||
| NPI: | 1285792945 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTERPOINTE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2633 P ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685033528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024758717 | ||||||||
| FaxNumber: | 4024756728 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 S 13TH ST | ||||||||
| Address2: | |||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685083533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024755161 | ||||||||
| FaxNumber: | 4024753300 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| AuthorizedOfficialLastName: | SHIVELY | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 4024758717 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ORGANIZATION # NR | NE | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 251B00000X | NOT REQUIRED | NE | N | Agencies | Case Management | 251S00000X | NOT REQUIRED | NE | N | Agencies | Community/Behavioral Health | 101YM0800X | ORGANIZATION # NR | NE | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 10025213000 | 05 | NE | MEDICAID |