Provider Demographics
NPI:1366690596
Name:KENDRA MCCALLIE LIMHP, LLC
Entity Type:Organization
Organization Name:KENDRA MCCALLIE LIMHP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCALLIE
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, CMSW
Authorized Official - Phone:402-689-6135
Mailing Address - Street 1:535 FORTUNE DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3428
Mailing Address - Country:US
Mailing Address - Phone:402-689-6135
Mailing Address - Fax:402-916-9757
Practice Address - Street 1:535 FORTUNE DR.
Practice Address - Street 2:STE 130
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046
Practice Address - Country:US
Practice Address - Phone:402-689-6135
Practice Address - Fax:402-916-9757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE279282Medicare UPIN