Provider Demographics
NPI:1962844514
Name:HEALTHVINE LLC
Entity Type:Organization
Organization Name:HEALTHVINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLEHARTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:402-214-4417
Mailing Address - Street 1:1325 S 78TH AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-1406
Mailing Address - Country:US
Mailing Address - Phone:402-214-4417
Mailing Address - Fax:
Practice Address - Street 1:1325 S 78TH AVE
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1406
Practice Address - Country:US
Practice Address - Phone:402-214-4417
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE74647251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care