Healthcare Provider Details

I. General information

NPI: 1053276634
Provider Name (Legal Business Name): PEKIDEMBE BANKATI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
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: 531-600-7073
Mailing address:
  • Phone: 531-600-3934
  • Fax: 531-600-7073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: