Healthcare Provider Details

I. General information

NPI: 1063236180
Provider Name (Legal Business Name): LILLIAN HENRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14210 ARBOR ST STE A
OMAHA NE
68144-2382
US

IV. Provider business mailing address

11265 S 201ST ST
GRETNA NE
68028-4586
US

V. Phone/Fax

Practice location:
  • Phone: 531-999-1133
  • Fax:
Mailing address:
  • Phone: 402-708-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: