Healthcare Provider Details

I. General information

NPI: 1801422357
Provider Name (Legal Business Name): BENEFICENT4U LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 6TH CORSO
NEBRASKA CITY NE
68410-2747
US

IV. Provider business mailing address

320 N 68TH ST
OMAHA NE
68132-2648
US

V. Phone/Fax

Practice location:
  • Phone: 402-713-0110
  • Fax: 402-713-0285
Mailing address:
  • Phone: 402-541-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TISHA KIM ELLIS
Title or Position: PMHNP-BC
Credential: APRN NP
Phone: 402-541-2230