Provider Demographics
NPI:1073392684
Name:CALCUTTA 24601 LLC
Entity Type:Organization
Organization Name:CALCUTTA 24601 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. MCFADDEN
Authorized Official - Prefix:
Authorized Official - First Name:JENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:402-200-8837
Mailing Address - Street 1:11605 MIRACLE HILLS DR STE 300
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11605 MIRACLE HILLS DR STE 300
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4467
Practice Address - Country:US
Practice Address - Phone:402-238-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty