Healthcare Provider Details

I. General information

NPI: 1811852296
Provider Name (Legal Business Name): ASHLY M DE LA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 N 103RD ST STE 401
OMAHA NE
68134-1010
US

IV. Provider business mailing address

5421 N 103RD ST STE 401
OMAHA NE
68134-1010
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-2525
  • Fax: 402-393-2441
Mailing address:
  • Phone: 402-393-2525
  • Fax: 402-393-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA202002
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: