MEDICARE: STACY GRANTSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1356153951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY GRANTSKI

Provider Business Mailing Address
First Line	:	3341 S 68TH CT APT 3341
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-3636
Country	:	US
Telephone Number	:	402-590-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 S 46TH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68106-2042
Country	:	US
Telephone Number	:	402-612-0485
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2025
Last Update Date	:	01/22/2025

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Directions to “ STACY GRANTSKI ” Practice Location

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