Provider Demographics
NPI:1982272993
Name:HEALING STONE 1
Entity Type:Organization
Organization Name:HEALING STONE 1
Other - Org Name:HEALING STONE
Other - Org Type:Other Name
Authorized Official - Title/Position:PLADC
Authorized Official - Prefix:
Authorized Official - First Name:JUDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-577-8725
Mailing Address - Street 1:6012 N 102ND ST # 642042
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68134-1030
Mailing Address - Country:US
Mailing Address - Phone:402-557-8725
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST # 416P
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2939
Practice Address - Country:US
Practice Address - Phone:402-557-8725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEHOOO1HFOtherREGISTERED SERVICE PROVIDERS
NEH0001HFMedicaid
NE90853Medicaid
NE90834OtherREGISTERED SERVICE PROVIDERS
NE90834Medicaid
NE90853OtherREGISTERED SERVICE PROVIDERS