Healthcare Provider Details

I. General information

NPI: 1679517684
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF NEBRASKA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2231 LINCOLN RD
BELLEVUE NE
68005-3907
US

IV. Provider business mailing address

1080 MARINA VILLAGE PKWY SUITE 100
ALAMEDA CA
94501-1078
US

V. Phone/Fax

Practice location:
  • Phone: 402-291-1203
  • Fax: 402-291-3915
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: LORENA LOPEZ
Title or Position: PROVIDER RELATIONS SUPERVISOR
Credential:
Phone: 510-337-7950