Healthcare Provider Details

I. General information

NPI: 1790625028
Provider Name (Legal Business Name): RYAN GRIFFIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11330 Q ST STE 230
OMAHA NE
68137-3679
US

IV. Provider business mailing address

11330 Q ST STE 230
OMAHA NE
68137-3679
US

V. Phone/Fax

Practice location:
  • Phone: 402-312-7271
  • Fax:
Mailing address:
  • Phone: 402-312-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: