Healthcare Provider Details

I. General information

NPI: 1972681757
Provider Name (Legal Business Name): COOPER VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8502 MORMON BRIDGE RD
OMAHA NE
68152-2150
US

IV. Provider business mailing address

8502 MORMON BRIDGE RD PO BOX 12150
OMAHA NE
68152-2150
US

V. Phone/Fax

Practice location:
  • Phone: 402-457-1398
  • Fax: 402-457-1405
Mailing address:
  • Phone: 402-457-1398
  • Fax: 402-457-1405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number110200
License Number StateNE

VIII. Authorized Official

Name: MS. SONJA SUE MCKAY
Title or Position: BILLING COORDINATOR
Credential:
Phone: 402-457-1398