Healthcare Provider Details

I. General information

NPI: 1255296992
Provider Name (Legal Business Name): NJIVA ARK,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13909 MANDERSON PLZ APT 201
OMAHA NE
68164-6228
US

IV. Provider business mailing address

13909 MANDERSON PLZ APT 201
OMAHA NE
68164-6228
US

V. Phone/Fax

Practice location:
  • Phone: 402-739-1141
  • Fax:
Mailing address:
  • Phone: 402-739-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TSUNGAI NJIVA
Title or Position: OWNER
Credential: PROVIDER
Phone: 402-739-1141