Provider Demographics
NPI:1346579778
Name:KVC BEHAVIORAL HEALTHCARE NEBRASKA
Entity Type:Organization
Organization Name:KVC BEHAVIORAL HEALTHCARE NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GASCA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-301-1086
Mailing Address - Street 1:10909 MILL VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3985
Mailing Address - Country:US
Mailing Address - Phone:402-301-1086
Mailing Address - Fax:
Practice Address - Street 1:1111 GRUNDMAN BOULEVARD
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410
Practice Address - Country:US
Practice Address - Phone:402-301-1086
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-14
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health