Healthcare Provider Details

I. General information

NPI: 1790227692
Provider Name (Legal Business Name): CHEERISH S ELLIS NA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4721 TROUT LN
BLAIR NE
68008-6286
US

IV. Provider business mailing address

4721 TROUT LN
BLAIR NE
68008-6286
US

V. Phone/Fax

Practice location:
  • Phone: 402-658-8200
  • Fax:
Mailing address:
  • Phone: 402-658-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number125151
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number125151
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: