Provider Demographics
NPI:1871716043
Name:SOURCENET, INC.
Entity type:Organization
Organization Name:SOURCENET, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:GROOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-933-7886
Mailing Address - Street 1:1934 S 48TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3217
Mailing Address - Country:US
Mailing Address - Phone:402-933-7886
Mailing Address - Fax:402-933-7886
Practice Address - Street 1:1934 S 48TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3217
Practice Address - Country:US
Practice Address - Phone:402-933-7886
Practice Address - Fax:402-933-7886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management