Provider Demographics
NPI:1083114821
Name:OMAHA TRIBE OF NEBRASKA
Entity Type:Organization
Organization Name:OMAHA TRIBE OF NEBRASKA
Other - Org Name:OMAHA TRIBE ALCOHOL PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH SYSTEMS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-837-5381
Mailing Address - Street 1:100 INDIAN HILLS DRIVE
Mailing Address - Street 2:PO BOX 250
Mailing Address - City:MACY
Mailing Address - State:NE
Mailing Address - Zip Code:68039-0250
Mailing Address - Country:US
Mailing Address - Phone:402-837-5381
Mailing Address - Fax:402-837-5271
Practice Address - Street 1:575 INDIAN HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:MACY
Practice Address - State:NE
Practice Address - Zip Code:68039-0250
Practice Address - Country:US
Practice Address - Phone:402-837-5381
Practice Address - Fax:402-837-5271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-19
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility