Healthcare Provider Details

I. General information

NPI: 1508562828
Provider Name (Legal Business Name): PRIDE RIDGE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 08/06/2025
Certification Date: 08/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 CORNHUSKER RD STE 105 PMB 351
BELLEVUE NE
68005-7911
US

IV. Provider business mailing address

505 CORNHUSKER RD STE 105 PMB 351
BELLEVUE NE
68005-7911
US

V. Phone/Fax

Practice location:
  • Phone: 402-915-0499
  • Fax:
Mailing address:
  • Phone: 402-915-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PETER WANGAI
Title or Position: OWNER
Credential:
Phone: 402-915-0499