Provider Demographics
NPI:1265098172
Name:NEURO HEALTH, PC
Entity type:Organization
Organization Name:NEURO HEALTH, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERNST
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:531-333-9032
Mailing Address - Street 1:3500 POTOMAC LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5452
Mailing Address - Country:US
Mailing Address - Phone:402-318-6340
Mailing Address - Fax:
Practice Address - Street 1:1917 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4642
Practice Address - Country:US
Practice Address - Phone:531-333-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-15
Last Update Date:2020-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty