Provider Demographics
NPI:1518503093
Name:BEHAVIORAL HEALTH OF OMAHA
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH OF OMAHA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-650-5089
Mailing Address - Street 1:7253 GROVER ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3580
Mailing Address - Country:US
Mailing Address - Phone:402-650-5089
Mailing Address - Fax:402-390-9070
Practice Address - Street 1:7253 GROVER ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3580
Practice Address - Country:US
Practice Address - Phone:402-650-5089
Practice Address - Fax:402-390-9070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health