Healthcare Provider Details

I. General information

NPI: 1184996258
Provider Name (Legal Business Name): CHILDREN'S HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S 84TH ST
OMAHA NE
68124-3215
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-7777
  • Fax:
Mailing address:
  • Phone: 402-955-6826
  • Fax: 402-955-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number2068
License Number StateNE

VIII. Authorized Official

Name: CHANDA C CHACON
Title or Position: PRESIDENT & CEO
Credential:
Phone: 402-955-6826