Healthcare Provider Details

I. General information

NPI: 1760477525
Provider Name (Legal Business Name): DELMAR GARDENS OF OMAHA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 DORCAS ST
OMAHA NE
68108
US

IV. Provider business mailing address

825 DORCAS ST
OMAHA NE
68108
US

V. Phone/Fax

Practice location:
  • Phone: 402-926-4444
  • Fax: 402-393-8230
Mailing address:
  • Phone: 402-926-4444
  • Fax: 402-393-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number261027
License Number StateNE

VIII. Authorized Official

Name: KEN MARX
Title or Position: CFO
Credential:
Phone: 636-733-7000