Healthcare Provider Details

I. General information

NPI: 1487218889
Provider Name (Legal Business Name): MADONNA SCHOOL & COMMUNITY-BASED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7197 PINE ST
OMAHA NE
68106-2811
US

IV. Provider business mailing address

7197 PINE ST
OMAHA NE
68106-2811
US

V. Phone/Fax

Practice location:
  • Phone: 402-556-1883
  • Fax:
Mailing address:
  • Phone: 402-556-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: TABITHA KEATING
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 402-556-1883