Healthcare Provider Details

I. General information

NPI: 1972662047
Provider Name (Legal Business Name): HEARTLAND FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

437 JEFFERSON RD
FREMONT NE
68025
US

IV. Provider business mailing address

2101 S 42ND ST
OMAHA NE
68105-2909
US

V. Phone/Fax

Practice location:
  • Phone: 402-721-5099
  • Fax: 402-721-5438
Mailing address:
  • Phone: 402-553-3000
  • Fax: 402-553-3133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN JEANETTA
Title or Position: PRESIDENT CEO
Credential: MBA, MSW
Phone: 402-552-7402