Healthcare Provider Details

I. General information

NPI: 1790699098
Provider Name (Legal Business Name): CALEB COLEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2582 VANE ST
OMAHA NE
68112-3166
US

IV. Provider business mailing address

4805 N 72ND ST # NE68134
OMAHA NE
68134-2304
US

V. Phone/Fax

Practice location:
  • Phone: 531-233-7422
  • Fax:
Mailing address:
  • Phone: 402-571-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: