Provider Demographics
NPI:1730647611
Name:INTEGRATED SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:INTEGRATED SUPPORT SERVICES LLC
Other - Org Name:COMPLETE FAMILY TREATMENT SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, LADC
Authorized Official - Phone:402-770-3764
Mailing Address - Street 1:9633 HOLLOW TREE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-9535
Mailing Address - Country:US
Mailing Address - Phone:402-770-3764
Mailing Address - Fax:
Practice Address - Street 1:10846 JOHN GALT BLVD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2306
Practice Address - Country:US
Practice Address - Phone:402-325-1290
Practice Address - Fax:402-817-7312
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED SUPPORT SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-09
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)