Provider Demographics
NPI:1881866929
Name:ATTACHMENT AND TRAUMA CENTER OF NEBRASKA, LLC
Entity Type:Organization
Organization Name:ATTACHMENT AND TRAUMA CENTER OF NEBRASKA, LLC
Other - Org Name:THE ATTACHMENT AND TRAUMA CENTER OF NEBRASKA, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-403-0190
Mailing Address - Street 1:638 N 109TH PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1722
Mailing Address - Country:US
Mailing Address - Phone:402-403-0190
Mailing Address - Fax:402-932-4121
Practice Address - Street 1:638 N 109TH PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1722
Practice Address - Country:US
Practice Address - Phone:402-403-0190
Practice Address - Fax:402-932-4121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2023-09-05
Deactivation Date:2023-08-05
Deactivation Code:
Reactivation Date:2023-08-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty