Healthcare Provider Details

I. General information

NPI: 1073847844
Provider Name (Legal Business Name): HOME RESPIRATORY WITH HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7602 PARK DR SUITE B
RALSTON NE
68127-3944
US

IV. Provider business mailing address

7602 PARK DR STE B
RALSTON NE
68127-3944
US

V. Phone/Fax

Practice location:
  • Phone: 402-614-4622
  • Fax: 402-614-4726
Mailing address:
  • Phone: 402-614-4622
  • Fax: 402-614-4726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN P JESUS
Title or Position: RESPIRATORY THERAPIST
Credential:
Phone: 402-614-4622