Organization
CANOPY SUPPORTIVE SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA RENAE NICHOLSON (CEO)
(402) 570-4673
Entity
Organization
Contact information
Practice address
955 N 28TH AVE, OMAHA, NE 68131-1503
(402) 570-4673
(402) 884-9018
Mailing address
955 N 28TH AVE, OMAHA, NE 68131-1503
(402) 570-4673
(402) 884-9018
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/20/2025
Last updated
03/20/2025
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