Provider Demographics
NPI:1578852968
Name:BRYAN LGH WEST INDEPENDENCE CENTER
Entity type:Organization
Organization Name:BRYAN LGH WEST INDEPENDENCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:MOOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-481-1111
Mailing Address - Street 1:1650 LAKE ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3734
Mailing Address - Country:US
Mailing Address - Phone:402-481-5268
Mailing Address - Fax:402-481-5495
Practice Address - Street 1:1650 LAKE ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3734
Practice Address - Country:US
Practice Address - Phone:402-481-5268
Practice Address - Fax:402-481-5495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE832324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility