Healthcare Provider Details

I. General information

NPI: 1285523647
Provider Name (Legal Business Name): ADVANCE INTERVENTION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3610 DODGE ST STE 105
OMAHA NE
68131-3218
US

IV. Provider business mailing address

3610 DODGE ST STE 105
OMAHA NE
68131-3218
US

V. Phone/Fax

Practice location:
  • Phone: 402-319-1264
  • Fax: 402-319-1264
Mailing address:
  • Phone: 402-319-1264
  • Fax: 402-319-1264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANNA TUKWAJE MICHAEL
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 402-319-1264