Provider Demographics
NPI:1255140091
Name:INNERVISION LLC
Entity type:Organization
Organization Name:INNERVISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HUNTER-RUTLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-779-5636
Mailing Address - Street 1:5266 WATERFORD AVENUE CIR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68133-4852
Mailing Address - Country:US
Mailing Address - Phone:402-779-5636
Mailing Address - Fax:
Practice Address - Street 1:8790 F ST STE 121
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1529
Practice Address - Country:US
Practice Address - Phone:402-779-5636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)