Provider Demographics
NPI:1457154361
Name:VALENTINE, DESIRE
Entity type:Individual
Prefix:
First Name:DESIRE
Middle Name:
Last Name:VALENTINE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 HARNEY ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2318
Mailing Address - Country:US
Mailing Address - Phone:402-502-3513
Mailing Address - Fax:
Practice Address - Street 1:1905 HARNEY ST STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2318
Practice Address - Country:US
Practice Address - Phone:402-502-3513
Practice Address - Fax:402-502-3513
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-28
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110448385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child