| Lifesource Of North Carolina | |
|
2900 W E St North Platte NE 69101-1803 | |
| (910) 742-9243 | |
| (888) 746-1787 |
| Full Name | Lifesource Of North Carolina |
|---|---|
| Speciality | Social Worker |
| Location | 2900 W E St, North Platte, Nebraska |
| Authorized Official Name and Position | Peggy Baddour (PRESIDENT) |
| Authorized Official Contact | 9107779165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifesource Of North Carolina Po Box 538622 Atlanta GA 30353-8622 Ph: (910) 535-1211 | Lifesource Of North Carolina 2900 W E St North Platte NE 69101-1803 Ph: (910) 742-9243 |
| NPI Number | 1093350647 |
|---|---|
| Provider Enumeration Date | 11/07/2019 |
| Last Update Date | 03/25/2021 |
| Certification Date | 03/25/2021 |
| Medicare PECOS PAC ID | 7416132428 |
|---|---|
| Medicare Enrollment ID | O20200114002495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093350647 | NPI | - | NPPES |
| Provider Name | Janet M Bock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942379516 PECOS PAC ID: 8325109903 Enrollment ID: I20081202000451 |
| Provider Name | Nathan Dg Herman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689987836 PECOS PAC ID: 5193977023 Enrollment ID: I20121128000586 |
| Provider Name | Nancy G Mize |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1902945033 PECOS PAC ID: 2567770506 Enrollment ID: I20150924002289 |
| Provider Name | Ana Cerrato-young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720327752 PECOS PAC ID: 2567899800 Enrollment ID: I20200225003047 |
| Provider Name | Jill Sims-hill |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699720284 PECOS PAC ID: 5991985392 Enrollment ID: I20200714000256 |
| Provider Name | Barbara Joan Rubin |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1669801551 PECOS PAC ID: 7911241179 Enrollment ID: I20220207001570 |
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