Individual
AWA PISSINABA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12602 AMES PLZ APT 105, OMAHA, NE 68164-1890
(256) 613-3414
Mailing address
12602 AMES PLZ APT 105, OMAHA, NE 68164-1890
(256) 613-3414
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
12/17/2024
Last updated
02/12/2025
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