Healthcare Provider Details

I. General information

NPI: 1629220991
Provider Name (Legal Business Name): GREAT PLAINS GERIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 10/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13927 MONROE ST
OMAHA NE
68137-4044
US

IV. Provider business mailing address

13927 MONROE ST
OMAHA NE
68137-4044
US

V. Phone/Fax

Practice location:
  • Phone: 402-733-3448
  • Fax:
Mailing address:
  • Phone: 402-733-3448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number110846
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberJ-113706
License Number StateIA

VIII. Authorized Official

Name: MISS GINGER LEE ROGERS
Title or Position: CEO
Credential: APRN
Phone: 402-733-3448