Organization
PONCA TRIBE OF NEBRASKA
Active
Other names
Ponca Behavioral Health Services, Fred LeRoy Health & Wellness Center, Ponca Hills Health & Wellness Center, Ponca Clinical Services, Ponca Dental Services, Ponca Population Health Services, Ponca Health Services, Ponca Pharmacy Services
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN M RIEB (COMPLIANCE OFFICER)
(402) 315-2772
Entity
Organization
Contact information
Practice address
2602 J ST, OMAHA, NE 68107-1643
(402) 733-3612
(402) 734-7156
Mailing address
5805 S 86TH CIR, OMAHA, NE 68127-4145
(402) 315-2760
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
251K00000X
Public Health or Welfare Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
Other
Enumeration date
09/12/2007
Last updated
10/22/2018
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