Healthcare Provider Details

I. General information

NPI: 1184561052
Provider Name (Legal Business Name): CHARNEL DOUGLAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 S 180TH ST
OMAHA NE
68136-2008
US

IV. Provider business mailing address

11110 S 180TH ST
OMAHA NE
68136-2008
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-9500
  • Fax:
Mailing address:
  • Phone: 402-955-9500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: