1790771301 NPI number — DELMAR GARDENS OF OMAHA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790771301 NPI number — DELMAR GARDENS OF OMAHA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DELMAR GARDENS OF OMAHA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. JOSEPH VILLA HOMECARE & HOSPICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790771301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 DORCAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-926-4444
Provider Business Mailing Address Fax Number:
402-393-8230

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 DORCAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-926-4444
Provider Business Practice Location Address Fax Number:
402-393-8230
Provider Enumeration Date:
09/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARX
Authorized Official First Name:
KEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
636-733-7000

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  HOSPICE24 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100251402-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".




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