Healthcare Provider Details

I. General information

NPI: 1952241176
Provider Name (Legal Business Name): SERENOVA HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4129 MIAMI ST
OMAHA NE
68111-3432
US

IV. Provider business mailing address

4129 MIAMI ST
OMAHA NE
68111-3432
US

V. Phone/Fax

Practice location:
  • Phone: 402-279-6009
  • Fax: 402-279-6009
Mailing address:
  • Phone: 402-279-6009
  • Fax: 402-279-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: EDOZIE NWAGBARA
Title or Position: MBR
Credential:
Phone: 402-279-6009