Healthcare Provider Details

I. General information

NPI: 1750559332
Provider Name (Legal Business Name): HEARTLAND FAMILY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 12/10/2019
Certification Date: 12/10/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 SAHLER ST
OMAHA NE
68104-5203
US

IV. Provider business mailing address

2101 S 42ND ST
OMAHA NE
68105-2947
US

V. Phone/Fax

Practice location:
  • Phone: 402-342-9555
  • Fax:
Mailing address:
  • Phone: 402-553-3000
  • Fax: 402-552-7444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10025597400
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number10025597400
License Number StateNE

VIII. Authorized Official

Name: SALLY WUNDERLICH
Title or Position: EXECUTIVE ASST.
Credential:
Phone: 402-552-7446