Healthcare Provider Details

I. General information

NPI: 1730466228
Provider Name (Legal Business Name): ALIGN CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 10/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4102 WOOLWORTH AVE SUITE 100
OMAHA NE
68105-1851
US

IV. Provider business mailing address

7914 W DODGE RD #404
OMAHA NE
68114-3417
US

V. Phone/Fax

Practice location:
  • Phone: 402-594-5550
  • Fax: 888-491-9836
Mailing address:
  • Phone: 402-881-0081
  • Fax: 800-761-7015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHANDRA LYNN WILKINS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 402-881-0081