Provider Demographics
NPI:1265923502
Name:MIDLAND MODESTY HOME HEALTHCARE LLC
Entity type:Organization
Organization Name:MIDLAND MODESTY HOME HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:NGOEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-932-3643
Mailing Address - Street 1:11414 W CENTER RD STE 340
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4425
Mailing Address - Country:US
Mailing Address - Phone:402-932-3643
Mailing Address - Fax:
Practice Address - Street 1:11414 W CENTER RD STE 340
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4425
Practice Address - Country:US
Practice Address - Phone:402-932-3643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEHHA201801251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health