Healthcare Provider Details

I. General information

NPI: 1053588582
Provider Name (Legal Business Name): HEARTLAND FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4318 FORT ST
OMAHA NE
68111-1849
US

IV. Provider business mailing address

2101 S 42ND ST
OMAHA NE
68105-2909
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-7020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DIANA ROBERTS
Title or Position: PSYCH PD
Credential:
Phone: 402-552-7459