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General NPI Number Information
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NPI Number | 1982097762
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Entity Type | Organization
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Legal Business Name | EBJ DETERDING, LLC
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 2120 S 56TH ST SUITE 205
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City | LINCOLN
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State | NE
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Zip | 68506-2118
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Country | US
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Telephone | 402-488-4421
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Fax | 888-456-0118
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Provider Business Mailing Address
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Address Line | 2120 S 56TH ST SUITE 205
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City | LINCOLN
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State | NE
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Zip | 68506
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Country | US
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Telephone | 402-488-4421
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Fax | 888-456-0118
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMIE J DETERDING
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Credential |
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Telephone | 402-488-4421
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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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