Healthcare Provider Details

I. General information

NPI: 1356269435
Provider Name (Legal Business Name): MANASICK ALGAZAFI IDRIS ADAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

418 N CODDINGTON AVE
LINCOLN NE
68528-1711
US

IV. Provider business mailing address

418 N CODDINGTON AVE
LINCOLN NE
68528-1711
US

V. Phone/Fax

Practice location:
  • Phone: 402-610-9214
  • Fax:
Mailing address:
  • Phone: 402-610-9214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: