Provider Demographics
NPI:1659991719
Name:B.A.M.B LLC
Entity Type:Organization
Organization Name:B.A.M.B LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:METOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-957-5290
Mailing Address - Street 1:1847 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68110-2416
Mailing Address - Country:US
Mailing Address - Phone:402-957-5290
Mailing Address - Fax:
Practice Address - Street 1:1847 N 17TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68110-2416
Practice Address - Country:US
Practice Address - Phone:402-957-5290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-19
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home