Healthcare Provider Details

I. General information

NPI: 1265342166
Provider Name (Legal Business Name): RODALE ERWIN-HALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3117 MIAMI ST
OMAHA NE
68111-3773
US

IV. Provider business mailing address

2910 N 63RD ST
OMAHA NE
68104-3352
US

V. Phone/Fax

Practice location:
  • Phone: 402-378-4197
  • Fax:
Mailing address:
  • Phone: 402-502-3513
  • Fax: 402-512-9047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: