Provider Demographics
NPI:1003979840
Name:EASTERN NEBRASKA COMMUNITY ACTION PARTNERSHIP
Entity Type:Organization
Organization Name:EASTERN NEBRASKA COMMUNITY ACTION PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LIMHP, LPC, NCC
Authorized Official - Phone:402-453-5656
Mailing Address - Street 1:2406 FOWLER AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-2013
Mailing Address - Country:US
Mailing Address - Phone:402-453-5656
Mailing Address - Fax:402-451-3057
Practice Address - Street 1:2406 FOWLER AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2013
Practice Address - Country:US
Practice Address - Phone:402-453-5656
Practice Address - Fax:402-451-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NESAT046251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========12Medicaid
NE086058Medicare ID - Type Unspecified