Provider Demographics
NPI:1114259108
Name:MIDLAND MODESTY HOME HEALTHCARE
Entity Type:Organization
Organization Name:MIDLAND MODESTY HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FITZGERALD
Authorized Official - Middle Name:O
Authorized Official - Last Name:TAMBE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:402-932-3643
Mailing Address - Street 1:2416 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-8082
Mailing Address - Country:US
Mailing Address - Phone:402-932-3643
Mailing Address - Fax:402-932-3642
Practice Address - Street 1:2416 LAKEWOOD DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-8082
Practice Address - Country:US
Practice Address - Phone:402-932-3643
Practice Address - Fax:402-932-3642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-02
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHHA200901251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health