Provider Demographics
NPI:1104657832
Name:HOPI COLLECTIVE CARE
Entity type:Organization
Organization Name:HOPI COLLECTIVE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLESCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-973-0845
Mailing Address - Street 1:6795 EMMET ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3127
Mailing Address - Country:US
Mailing Address - Phone:402-807-5242
Mailing Address - Fax:531-213-2377
Practice Address - Street 1:11207 W DODGE RD STE 250
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-2650
Practice Address - Country:US
Practice Address - Phone:402-807-5242
Practice Address - Fax:531-213-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty