Healthcare Provider Details

I. General information

NPI: 1982272993
Provider Name (Legal Business Name): HEALING STONE 1
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 S 42ND ST # 416P
OMAHA NE
68105-2939
US

IV. Provider business mailing address

6012 N 102ND ST # 642042
OMAHA NE
68134-1030
US

V. Phone/Fax

Practice location:
  • Phone: 402-557-8725
  • Fax:
Mailing address:
  • Phone: 402-557-8725
  • 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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDI SCOTT
Title or Position: PLADC
Credential:
Phone: 402-577-8725