Healthcare Provider Details

I. General information

NPI: 1750208229
Provider Name (Legal Business Name): ANTONIO BERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 FORT CROOK RD S STE 300
BELLEVUE NE
68005-2990
US

IV. Provider business mailing address

7391 N 77TH ST
OMAHA NE
68122-5239
US

V. Phone/Fax

Practice location:
  • Phone: 402-507-9797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: