Provider Demographics
NPI:1568790400
Name:KVC BEHAVIORALL HEALTHCARE NEBRASKA
Entity Type:Organization
Organization Name:KVC BEHAVIORALL HEALTHCARE NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:GASCA
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-301-1086
Mailing Address - Street 1:10909 MILL VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3985
Mailing Address - Country:US
Mailing Address - Phone:402-301-1108
Mailing Address - Fax:
Practice Address - Street 1:510 BRADFORD ST
Practice Address - Street 2:SUITE A
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-1708
Practice Address - Country:US
Practice Address - Phone:402-770-4180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health