Provider Demographics
NPI:1013125244
Name:HAVCO HEALTH INC.
Entity type:Organization
Organization Name:HAVCO HEALTH INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAVLICEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD APRN-BC, NP-C
Authorized Official - Phone:402-488-3946
Mailing Address - Street 1:6831 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1548
Mailing Address - Country:US
Mailing Address - Phone:402-488-3946
Mailing Address - Fax:402-488-6031
Practice Address - Street 1:1630 S 70TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-1500
Practice Address - Country:US
Practice Address - Phone:402-488-3946
Practice Address - Fax:402-488-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110806261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099969Medicare PIN