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General NPI Number Information
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NPI Number | 1275476897
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Entity Type | Individual
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Provider Name | MR. ROBERT W GROVER
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Gender | Male
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Dates
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Enumeration Date | 04/09/2026
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Last Update Date | 04/09/2026
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Provider Practice Location Address
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Address Line | 4980 S 118TH ST
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City | OMAHA
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State | NE
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Zip | 68137-2200
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Country | US
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Telephone | 531-710-0104
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Fax |
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Provider Business Mailing Address
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Address Line | 2814 N 169TH ST
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City | OMAHA
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State | NE
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Zip | 68116-2689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State | NE
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