Provider Demographics
NPI:1477680999
Name:CHARTER HOME HEALTH OF OMAHA, LLC
Entity Type:Organization
Organization Name:CHARTER HOME HEALTH OF OMAHA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-665-4965
Mailing Address - Street 1:4905 S. 107TH AVE.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1965
Mailing Address - Country:US
Mailing Address - Phone:402-926-4088
Mailing Address - Fax:402-926-4197
Practice Address - Street 1:4905 S. 107TH AVE.
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1965
Practice Address - Country:US
Practice Address - Phone:402-926-4088
Practice Address - Fax:402-926-4197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHHA1043251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025245500Medicaid
NE10025245500Medicaid