Healthcare Provider Details

I. General information

NPI: 1891590048
Provider Name (Legal Business Name): PERSON CENTERED DEVELOPMENTAL DISABILITIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2026
Certification Date: 02/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4942 S 114TH ST
OMAHA NE
68137-2324
US

IV. Provider business mailing address

4942 S 114TH ST
OMAHA NE
68137-2324
US

V. Phone/Fax

Practice location:
  • Phone: 402-509-4480
  • Fax: 402-982-4099
Mailing address:
  • Phone: 402-509-4480
  • Fax: 402-982-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS CRYSTAL NICOLE EVERETT
Title or Position: CEO/DIRECTOR
Credential: RN
Phone: 402-509-4480