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? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |