Provider Demographics
NPI:1932777273
Name:REMINGTON SAMUELS, LLC
Entity Type:Organization
Organization Name:REMINGTON SAMUELS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REMINGTON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SAMUELS
Authorized Official - Suffix:
Authorized Official - Credentials:PLMHP, PCMSW
Authorized Official - Phone:402-683-0720
Mailing Address - Street 1:13304 W CENTER RD STE 110
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-3453
Mailing Address - Country:US
Mailing Address - Phone:402-683-0720
Mailing Address - Fax:402-915-5066
Practice Address - Street 1:13304 W CENTER RD STE 110
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3453
Practice Address - Country:US
Practice Address - Phone:402-683-0720
Practice Address - Fax:402-915-5066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026878000Medicaid