Provider Demographics
NPI:1518036755
Name:UTA HALEE GIRLS VILLAGE
Entity Type:Organization
Organization Name:UTA HALEE GIRLS VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-457-1398
Mailing Address - Street 1:10625 CALHOUN RD
Mailing Address - Street 2:PO BOX 12034
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68112-2034
Mailing Address - Country:US
Mailing Address - Phone:402-457-1398
Mailing Address - Fax:402-457-1405
Practice Address - Street 1:10625 CALHOUN RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68112-2034
Practice Address - Country:US
Practice Address - Phone:402-457-1398
Practice Address - Fax:402-457-1405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110200251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025222000Medicaid