1861515470 NPI number — COMMUNITY HME 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 1861515470 NPI number — COMMUNITY HME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HME 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:
Provider Other Organization Name Type Code:
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:
1861515470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9931 S 136TH ST
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68138-3937
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-592-2435
Provider Business Mailing Address Fax Number:
402-592-6914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 RICHLAND SQ
Provider Second Line Business Practice Location Address:
HWY 14
Provider Business Practice Location Address City Name:
RICHLAND CENTER
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53581-2947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-355-0774
Provider Business Practice Location Address Fax Number:
608-355-0787
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HALL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
402-592-2435

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  2307-45 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 41701900 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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