Healthcare Provider Details

I. General information

NPI: 1801708276
Provider Name (Legal Business Name): RENARD LOCKRIDGE JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13304 W CENTER RD STE 125
OMAHA NE
68144-3402
US

IV. Provider business mailing address

6518 S 137TH CIR
OMAHA NE
68137-4160
US

V. Phone/Fax

Practice location:
  • Phone: 402-252-5442
  • Fax:
Mailing address:
  • Phone: 531-225-4148
  • 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:
Title or Position:
Credential:
Phone: