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General NPI Number Information
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NPI Number | 1104295609
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Entity Type | Organization
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Legal Business Name | DIVERSIFIED HEALTHCARE INC.
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 5332 S 138TH ST STE 100
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City | OMAHA
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State | NE
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Zip | 68137-2945
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Country | US
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Telephone | 402-392-1818
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Fax | 402-392-0167
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Provider Business Mailing Address
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Address Line | 5332 S 138TH ST STE 100
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City | OMAHA
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State | NE
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Zip | 68137-2945
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Country | US
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Telephone | 402-392-1818
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Fax | 402-392-0167
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Authorized Official
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Title or Position | OWNER, ADMINISTRATOR, DHCS
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Name | PAULA STAPLETON
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Credential |
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Telephone | 402-392-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA201501
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License Number State | NE
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