Provider Demographics
NPI:1053112177
Name:DONALD, VIJAHNAY
Entity type:Individual
Prefix:
First Name:VIJAHNAY
Middle Name:
Last Name:DONALD
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 1:1515 N 112TH CT APT 5408
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5832
Mailing Address - Country:US
Mailing Address - Phone:402-871-2302
Mailing Address - Fax:
Practice Address - Street 1:1515 N 112TH CT APT 5408
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5832
Practice Address - Country:US
Practice Address - Phone:402-871-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities