Provider Demographics
NPI:1316743347
Name:HARRIS, ROBIN ASHLEY
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:ASHLEY
Last Name:HARRIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 S 42ND ST STE 402A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68105-2944
Mailing Address - Country:US
Mailing Address - Phone:833-214-0277
Mailing Address - Fax:
Practice Address - Street 1:1941 S 42ND ST STE 402A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2944
Practice Address - Country:US
Practice Address - Phone:833-214-0277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities