Provider Demographics
NPI:1609535210
Name:AGING OFFICE OF WESTERN NEBRASKA
Entity Type:Organization
Organization Name:AGING OFFICE OF WESTERN NEBRASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:BRUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-635-0851
Mailing Address - Street 1:1517 BROADWAY STE 122
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3184
Mailing Address - Country:US
Mailing Address - Phone:308-635-0851
Mailing Address - Fax:888-599-3935
Practice Address - Street 1:1517 BROADWAY STE 122
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3184
Practice Address - Country:US
Practice Address - Phone:308-635-0851
Practice Address - Fax:888-599-3935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty