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Individual provider Active NPI Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Omaha, NE

NPI 1013706746 · NPPES record last updated Apr 30, 2025

Key facts

NPI
1013706746
Entity type
Individual (NPI type 1)
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X
Practice address
1805 N 73Rd St
Omaha, NE 68114-1905
Phone
(402) 557-8583
NPI assigned
Apr 30, 2025
Sex
Male
Sole proprietor
Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Developmental Disability Center of Iowa LLC Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities Current
since May 4, 2025
Accepting new patients

Locations

1805 N 73rd St
Omaha, NE 68114
Phone (402) 575-8583

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X Yes

Addresses

Primary practice location

1805 N 73Rd St
Omaha, NE 68114-1905

Mailing address

1113 N 48TH Ave Apt 23
Omaha, NE 68132-1630

Other providers in Omaha, NE

All providers in Omaha, NE · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Nebraska

Sources for this page

Verify at the official NPI Registry.