Provider Demographics
NPI:1083810980
Name:NEBRASKA URBAN INDIAN HEALTH COALITION
Entity Type:Organization
Organization Name:NEBRASKA URBAN INDIAN HEALTH COALITION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT MARKETING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:TICKNOR
Authorized Official - Suffix:
Authorized Official - Credentials:AAS, PLADC
Authorized Official - Phone:402-346-0902
Mailing Address - Street 1:10912 V ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3730
Mailing Address - Country:US
Mailing Address - Phone:402-614-0585
Mailing Address - Fax:
Practice Address - Street 1:2240 LANDON CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2414
Practice Address - Country:US
Practice Address - Phone:402-346-0902
Practice Address - Fax:402-342-5290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-594324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility