NPIMap

Organization Active NPI

Community Life Skills Connection

  • Community/Behavioral Health Agency
  • Omaha, NE
National Provider Identifier
1801107677
Registry record updated Jun 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
399679 Issued in IA
Legal business name
COMMUNITY LIFE SKILLS CONNECTION
Practice address
3830 Burt St
Omaha, NE 68131-1819
Phone
(402) 690-0475
NPI assigned
Jun 28, 2010
Last updated
Jun 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2010

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

Authorized official

Name
Vicki Thomas-Davis, RN, MSN
Title
Executive Director
Phone
(402) 690-0475

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X 399679 IA Primary

Addresses

Primary practice location

3830 Burt St
Omaha, NE 68131-1819

Mailing address

PO Box 1928
Council Bluffs, IA 51502-1928
Phone (402) 690-0475

Other identifiers 1

IdentifierTypeStateIssuer
251S00000XMedicaidIA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277683200000",
    "number": "1801107677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1928",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515021928",
            "telephone_number": "402-690-0475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3830 BURT ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681311819",
            "telephone_number": "402-690-0475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY LIFE SKILLS CONNECTION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-28",
        "last_updated": "2010-06-28",
        "status": "A",
        "authorized_official_last_name": "THOMAS-DAVIS",
        "authorized_official_first_name": "VICKI",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "402-690-0475",
        "authorized_official_credential": "RN, MSN"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "IA",
            "license": "399679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251S00000X",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; 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.