Provider Demographics
NPI:1245840966
Name:ACTIVE HEARING HEALTH
Entity type:Organization
Organization Name:ACTIVE HEARING HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOPETZKY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:402-318-7863
Mailing Address - Street 1:18010 R PLZ STE 107
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-1923
Mailing Address - Country:US
Mailing Address - Phone:402-318-7863
Mailing Address - Fax:402-318-7885
Practice Address - Street 1:18010 R PLZ STE 107
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68135-1923
Practice Address - Country:US
Practice Address - Phone:402-318-7863
Practice Address - Fax:402-318-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and SpeechGroup - Single Specialty
No332S00000XSuppliersHearing Aid Equipment