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Organization subpart
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Provider details

NPI number
Authorized official
MS. RONTASHA NINA-MARIE JOHNSON LPN (AUTHORIZED ODDICIAL)
(402) 415-9639
Entity
Organization

Contact information

Practice address
927 2ND AVE APT 4, COUNCIL BLUFFS, IA 51501-4033
(402) 415-9639
Mailing address
7714 N 82ND AVE, OMAHA, NE 68122-1541
(402) 415-9639

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Enumeration date
09/20/2024
Last updated
09/20/2024
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