Provider Demographics
NPI:1780333591
Name:ADJINATA, JOELLE ELODIE SE I
Entity type:Individual
Prefix:MRS
First Name:JOELLE
Middle Name:ELODIE SE
Last Name:ADJINATA
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3509 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68147-1252
Mailing Address - Country:US
Mailing Address - Phone:402-612-9032
Mailing Address - Fax:
Practice Address - Street 1:3509 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-1252
Practice Address - Country:US
Practice Address - Phone:402-612-9032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities