Provider LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

PROVIDER LLC

Practice address

13516 Discovery Dr
Omaha, NE 68137

Phone

(502) 618-9786

NPI assigned

Jun 28, 2025

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Delanam GbegnonNPI 1104714153

Title

Owner

Phone

(502) 618-9786

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Delanam Gbegnon

  • Community/Behavioral Health Agency
  • Omaha, NE
  • NPI 1104714153
  NPD Authorized official
• Attia Ahebla

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Omaha, NE
  • NPI 1881584985

  Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1751068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751068800000",
    "number": "1407745243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13516 DISCOVERY DR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68137",
            "telephone_number": "502-618-9786"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13516 DISCOVERY DR",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "68137",
            "telephone_number": "502-618-9786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-28",
        "last_updated": "2025-06-28",
        "certification_date": "2025-06-27",
        "status": "A",
        "authorized_official_last_name": "GBEGNON",
        "authorized_official_first_name": "DELANAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-618-9786"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Prottsman
• Rachelle Suzanne Prouse
• Joanna Prout, MA
• Jessica Lynne Provaznik, PHARMD
• Lorraine Myers Provencher, M.D.
• Provision Eye Care LLC
• Jessica Prucha, PHARMD
• William Pruett, MD
• Ashlee Sue Pruis-Trapp, PLMHP
• Chase A Pruitt, DDS, MD

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Omaha, NE
• Providers in Omaha, NE by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.