Provider Demographics
NPI:1477186757
Name:HUONG LE PSYCHIATRIC CARE LLC
Entity Type:Organization
Organization Name:HUONG LE PSYCHIATRIC CARE LLC
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 1:4444 S 86TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9253
Mailing Address - Country:US
Mailing Address - Phone:402-476-7557
Mailing Address - Fax:
Practice Address - Street 1:4444 S 86TH ST STE 102
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:402-476-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-15
Last Update Date:2020-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098936024OtherPTAN
NE51582044201Medicaid