Provider Demographics
NPI:1710917448
Name:ALIVATION HEALTH, LLC
Entity Type:Organization
Organization Name:ALIVATION HEALTH, LLC
Other - Org Name:PREMIER PSYCHIATRIC GROUP, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:402-476-6060
Mailing Address - Street 1:8550 CUTHILLS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9467
Mailing Address - Country:US
Mailing Address - Phone:402-476-6060
Mailing Address - Fax:402-476-6809
Practice Address - Street 1:8550 CUTHILLS CIRCLE
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9467
Practice Address - Country:US
Practice Address - Phone:402-476-6060
Practice Address - Fax:402-476-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098936OtherPTAN
NE10025071300Medicaid