Provider Demographics
NPI:1205460037
Name:SUNCREST HOSPICE NEBRASKA LLC
Entity type:Organization
Organization Name:SUNCREST HOSPICE NEBRASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:GODFREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-849-0486
Mailing Address - Street 1:9800 S MONROE ST STE 809
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-4419
Mailing Address - Country:US
Mailing Address - Phone:801-849-0486
Mailing Address - Fax:801-849-0476
Practice Address - Street 1:1125 S 103RD ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-1071
Practice Address - Country:US
Practice Address - Phone:402-509-7655
Practice Address - Fax:402-939-8261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based