Healthcare Provider Details

I. General information

NPI: 1013715416
Provider Name (Legal Business Name): JACE TRUSTING HANDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 S 96TH ST STE 235
OMAHA NE
68127-1243
US

IV. Provider business mailing address

7737 GREENLEAF DR
LA VISTA NE
68128-2767
US

V. Phone/Fax

Practice location:
  • Phone: 402-706-8625
  • Fax:
Mailing address:
  • Phone: 402-706-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. GBENADE K. EDOH
Title or Position: DIRECTOR
Credential:
Phone: 402-706-8625