Healthcare Provider Details

I. General information

NPI: 1790501203
Provider Name (Legal Business Name): KINDRED CENTER FOR INDEPENDENCE L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2024
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 GOLDEN GATE DR
PAPILLION NE
68046-2837
US

IV. Provider business mailing address

1201 GOLDEN GATE DR
PAPILLION NE
68046-2837
US

V. Phone/Fax

Practice location:
  • Phone: 531-600-3934
  • Fax:
Mailing address:
  • Phone: 531-600-3934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. GILDAS AGBASSOU
Title or Position: DIRECTOR
Credential:
Phone: 531-600-3934