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General NPI Number Information
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NPI Number | 1497440788
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Entity Type | Organization
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Legal Business Name | STONEGATES HOME HEALTH LLC
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 16601 MERIDIAN ST
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City | OMAHA
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State | NE
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Zip | 68136-1396
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Country | US
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Telephone | 402-861-5442
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Fax | 402-939-0974
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Provider Business Mailing Address
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Address Line | 16601 MERIDIAN ST
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City | OMAHA
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State | NE
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Zip | 68136-1396
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Country | US
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Telephone | 402-861-5442
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Fax | 402-939-0974
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Authorized Official
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Title or Position | OWNER
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Name | KOFFI AMOUZOU
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Credential | RN
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Telephone | 402-861-5442
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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 |
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License Number State |
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