Basic Information
| Provider Information | |||||||||
| NPI: | 1447644455 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TR HEPBURN INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | O U R HOMES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2039 Q ST | ||||||||
| Address2: | APT 101 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685033643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024742121 | ||||||||
| FaxNumber: | 4024779752 | ||||||||
| Practice Location | |||||||||
| Address1: | 2039 Q ST | ||||||||
| Address2: | #101 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685033643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024742121 | ||||||||
| FaxNumber: | 4024779752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2015 | ||||||||
| LastUpdateDate: | 04/03/2015 | ||||||||
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| AuthorizedOfficialLastName: | HEPBURN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | FREDERICK | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/CO OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4024742121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TR HEPBURN INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | NE | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical | 101YA0400X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 363LP0808X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 101YM0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.