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General NPI Number Information
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NPI Number | 1801422357
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Entity Type | Organization
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Legal Business Name | BENEFICENT4U LLC
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 04/29/2020
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Provider Practice Location Address
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Address Line | 1120 6TH CORSO
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City | NEBRASKA CITY
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State | NE
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Zip | 68410-2747
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Country | US
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Telephone | 402-713-0110
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Fax | 402-713-0285
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Provider Business Mailing Address
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Address Line | 320 N 68TH ST
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City | OMAHA
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State | NE
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Zip | 68132-2648
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Country | US
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Telephone | 402-541-2230
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Fax |
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Authorized Official
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Title or Position | PMHNP-BC
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Name | TISHA KIM ELLIS
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Credential | APRN NP
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Telephone | 402-541-2230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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