MEDICARE: ALVINO WILKINS

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	320800000X	Mental Illness Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1164237392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALVINO WILKINS

Provider Business Mailing Address
First Line	:	3114 S 21ST ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68108-1804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 S 21ST ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68108-1804
Country	:	US
Telephone Number	:	402-677-0609
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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Directions to “ ALVINO WILKINS ” Practice Location

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