Healthcare Provider Details

I. General information

NPI: 1710917448
Provider Name (Legal Business Name): ALIVATION HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8550 CUTHILLS CIRCLE
LINCOLN NE
68526-9467
US

IV. Provider business mailing address

8550 CUTHILLS CIRCLE
LINCOLN NE
68526-9467
US

V. Phone/Fax

Practice location:
  • Phone: 402-476-6060
  • Fax: 402-476-6809
Mailing address:
  • Phone: 402-476-6060
  • Fax: 402-476-6809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: WALTER J. DUFFY
Title or Position: OWNER/CEO
Credential: M.D.
Phone: 402-476-6060