Provider Demographics
NPI:1760477525
Name:DELMAR GARDENS OF OMAHA, LLC
Entity Type:Organization
Organization Name:DELMAR GARDENS OF OMAHA, LLC
Other - Org Name:ST. JOSEPH VILLA HOMECARE & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-733-7000
Mailing Address - Street 1:825 DORCAS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68108
Mailing Address - Country:US
Mailing Address - Phone:402-926-4444
Mailing Address - Fax:402-393-8230
Practice Address - Street 1:825 DORCAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68108
Practice Address - Country:US
Practice Address - Phone:402-926-4444
Practice Address - Fax:402-393-8230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261027251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252553-00Medicaid
NE100252553-00Medicaid