Provider Demographics
NPI:1801422357
Name:BENEFICENT4U LLC
Entity type:Organization
Organization Name:BENEFICENT4U LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:TISHA
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN NP
Authorized Official - Phone:402-541-2230
Mailing Address - Street 1:320 N 68TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68132-2648
Mailing Address - Country:US
Mailing Address - Phone:402-541-2230
Mailing Address - Fax:
Practice Address - Street 1:1120 6TH CORSO
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2747
Practice Address - Country:US
Practice Address - Phone:402-713-0110
Practice Address - Fax:402-713-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health