Provider Demographics
NPI:1346827821
Name:P-31
Entity Type:Organization
Organization Name:P-31
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANICE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCCROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-415-6757
Mailing Address - Street 1:5404 N 49TH AVE # P31
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-1824
Mailing Address - Country:US
Mailing Address - Phone:402-415-6757
Mailing Address - Fax:
Practice Address - Street 1:5404 N 49TH AVE # P31
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-1824
Practice Address - Country:US
Practice Address - Phone:402-415-6757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE85769936Medicaid