Individual
MALIYA KERAE'A GRESHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3939 LAUREL AVE, OMAHA, NE 68111-1153
(402) 215-9616
Mailing address
3939 LAUREL AVE, OMAHA, NE 68111-1153
(402) 215-9616
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
H14144715
NE
Other
Enumeration date
03/27/2025
Last updated
03/27/2025
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