Provider Demographics
NPI:1043931801
Name:CAHILL, SUSAN RENEE (OWNER OF COMPANY)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RENEE
Last Name:CAHILL
Suffix:
Gender:F
Credentials:OWNER OF COMPANY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSON
Mailing Address - State:NE
Mailing Address - Zip Code:68629-4026
Mailing Address - Country:US
Mailing Address - Phone:402-809-3304
Mailing Address - Fax:402-892-9817
Practice Address - Street 1:111 E 8TH ST
Practice Address - Street 2:
Practice Address - City:CLARKSON
Practice Address - State:NE
Practice Address - Zip Code:68629-4026
Practice Address - Country:US
Practice Address - Phone:402-809-3304
Practice Address - Fax:402-892-9817
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
88-0677907OtherSTATE OF NE