MEDICARE: VERVE COLLABORATIVE HEALTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114484334
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERVE COLLABORATIVE HEALTH LLC

Provider Business Mailing Address
First Line	:	11404 W DODGE RD STE 300
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2511
Country	:	US
Telephone Number	:	402-898-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	11404 W DODGE RD STE 600
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2593
Country	:	US
Telephone Number	:	402-898-1113
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS AND TECHNOLOGY
Name	:	AARON JAMES BOSE
Credential	:
Telephone Number	:	402-898-1113

Provider Enumeration Date	:	02/24/2019
Last Update Date	:	01/06/2022

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