Provider Demographics
NPI:1346800059
Name:A SAFE PLACE TO LAND
Entity Type:Organization
Organization Name:A SAFE PLACE TO LAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:KADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:OMEROVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-421-1182
Mailing Address - Street 1:4719 PRESCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4719 PRESCOTT AVE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5456
Practice Address - Country:US
Practice Address - Phone:402-235-8184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100893757Medicaid