Provider Demographics
NPI:1255424040
Name:NEBRASKA HOME HEALTH - OPCO LLC
Entity type:Organization
Organization Name:NEBRASKA HOME HEALTH - OPCO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:TAIT
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-716-9655
Mailing Address - Street 1:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-1784
Mailing Address - Country:US
Mailing Address - Phone:888-667-5730
Mailing Address - Fax:208-346-7790
Practice Address - Street 1:7602 PARK DR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3944
Practice Address - Country:US
Practice Address - Phone:402-614-4622
Practice Address - Fax:402-614-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NEHHA1046251J00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100252733-00Medicaid
NE10025273300Medicaid