Healthcare Provider Details

I. General information

NPI: 1881408441
Provider Name (Legal Business Name): LORI SUE ECCLESTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 WESGAYE ST
GRETNA NE
68028-7849
US

IV. Provider business mailing address

207 WESGAYE ST
GRETNA NE
68028-7849
US

V. Phone/Fax

Practice location:
  • Phone: 402-616-6159
  • Fax:
Mailing address:
  • Phone: 402-616-6159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: