Mandy Broussard
Individual provider Active NPI Developmentally Disabled Services Day Training Agency · MC Cook, NE
NPI 1376340281 · NPPES record last updated Feb 27, 2025
Key facts
- NPI
- 1376340281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Developmentally Disabled Services Day Training Agency 251C00000X
- Practice address
- 506 E 12TH St
MC Cook, NE 69001-3599 - Phone
- (308) 745-1530
- NPI assigned
- Feb 27, 2025
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Trenton Nursing Home - Village of Trenton | Current | Accepting new patients | |
| Southwest Area Training Service | Day Training, Developmentally Disabled Services | Current |
Accepting new patients |
| County of Red Willow | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | Yes |
Addresses
Primary practice location
506 E 12TH St
MC Cook, NE 69001-3599
Mailing address
1111 E 2ND St
MC Cook, NE 69001-2625
Phone (720) 292-7903
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 470563788 | Medicaid | NE |
Other providers in MC Cook, NE
- Darla Bowling
- Michelle Braget
- Ellen Branham
- Breanna Branson
- Margaret Mary Brooks
- Patricia Brown
- Carli Bundy
- Julie C Burns
- Burrows Vision Clinic LLC
- Jessica Butterworth
All providers in MC Cook, NE · Developmentally Disabled Services Day Training Agency in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.