Provider Demographics
NPI:1457187445
Name:HEBRONIS HOME LLC
Entity type:Organization
Organization Name:HEBRONIS HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIDELE
Authorized Official - Middle Name:
Authorized Official - Last Name:NITEZEHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-217-8376
Mailing Address - Street 1:5127 69TH ST
Mailing Address - Street 2:
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-6907
Mailing Address - Country:US
Mailing Address - Phone:515-217-8376
Mailing Address - Fax:
Practice Address - Street 1:5127 69TH ST
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-6907
Practice Address - Country:US
Practice Address - Phone:515-217-8376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)