Provider Demographics
NPI:1477359974
Name:GANLONON COOVI, HUGUETTE B. CHANTAL
Entity type:Individual
Prefix:
First Name:HUGUETTE B.
Middle Name:CHANTAL
Last Name:GANLONON COOVI
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 1:3317 N 107TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-3664
Mailing Address - Country:US
Mailing Address - Phone:402-502-1035
Mailing Address - Fax:402-502-1478
Practice Address - Street 1:8924 N 161ST ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-6414
Practice Address - Country:US
Practice Address - Phone:402-812-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE000000320900000X
NE0000000320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities