Healthcare Provider Details

I. General information

NPI: 1003473513
Provider Name (Legal Business Name): ESOR REGOR DBA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 S 42ND ST # 512
OMAHA NE
68105-2939
US

IV. Provider business mailing address

1941 S 42ND ST # 512
OMAHA NE
68105-2939
US

V. Phone/Fax

Practice location:
  • Phone: 402-934-3303
  • Fax: 402-315-3296
Mailing address:
  • Phone: 402-934-3303
  • Fax: 402-315-3296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHANNON VARGAS
Title or Position: OWNER
Credential:
Phone: 402-934-3303