Healthcare Provider Details

I. General information

NPI: 1467259028
Provider Name (Legal Business Name): LOGAN HUPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11716 W DODGE RD
OMAHA NE
68154-2425
US

IV. Provider business mailing address

PO BOX 787
BOYS TOWN NE
68010-0787
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-0753
  • Fax: 402-403-5289
Mailing address:
  • Phone: 402-393-0753
  • Fax: 402-403-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: