Provider Demographics
NPI:1326536558
Name:PRIME HOME DEVELOPMENTAL DISABILITIES SERVICES, INC
Entity Type:Organization
Organization Name:PRIME HOME DEVELOPMENTAL DISABILITIES SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:BOJANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-932-0072
Mailing Address - Street 1:6818 GROVER ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3632
Mailing Address - Country:US
Mailing Address - Phone:402-932-0072
Mailing Address - Fax:402-932-0072
Practice Address - Street 1:6818 GROVER ST STE 200
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3632
Practice Address - Country:US
Practice Address - Phone:402-932-0072
Practice Address - Fax:402-932-0072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty