Healthcare Provider Details

I. General information

NPI: 1568191849
Provider Name (Legal Business Name): BEAR COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5858 WENNINGHOFF RD STE 2
OMAHA NE
68134-1911
US

IV. Provider business mailing address

5858 WENNINGHOFF RD STE 2
OMAHA NE
68134-1911
US

V. Phone/Fax

Practice location:
  • Phone: 402-512-3475
  • Fax: 402-206-2759
Mailing address:
  • Phone: 402-512-3475
  • Fax: 402-206-2759

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. PAYTON JIBRI HOGAN
Title or Position: CEO/OWNER
Credential:
Phone: 402-819-9712