Provider Demographics
NPI:1295742385
Name:DR BROZ AND ASSOCIATES, INC
Entity type:Organization
Organization Name:DR BROZ AND ASSOCIATES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BROZ
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP
Authorized Official - Phone:402-750-8712
Mailing Address - Street 1:1811 WEST 2ND STREET
Mailing Address - Street 2:SUITE 280
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-5445
Mailing Address - Country:US
Mailing Address - Phone:402-750-8712
Mailing Address - Fax:308-832-4401
Practice Address - Street 1:1811 WEST 2ND STREET
Practice Address - Street 2:SUITE 280
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-5445
Practice Address - Country:US
Practice Address - Phone:402-750-8712
Practice Address - Fax:308-832-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1000251B00000X
NELIMHP1000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========27Medicaid