Healthcare Provider Details

I. General information

NPI: 1255263240
Provider Name (Legal Business Name): MACI JEAN RUTLEDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 Q STREET SUITE 101C
OMAHA NE
68114
US

IV. Provider business mailing address

881 PARRY DR
CHADRON NE
69337-2729
US

V. Phone/Fax

Practice location:
  • Phone: 308-430-4671
  • Fax:
Mailing address:
  • Phone: 308-430-4671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number163997
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number163997
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number163997
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: