Individual
CORY BRUCE CARLOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7403 S 72ND AVE, LA VISTA, NE 68128-2624
(402) 515-4559
Mailing address
7403 S 72ND AVE, LA VISTA, NE 68128-2624
(402) 515-4559
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/07/2025
Last updated
03/07/2025
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