MEDICARE: CASSANDRA BOX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	112801	NE

General Provider Information

NPI Number	:	1104795624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA BOX

Provider Business Mailing Address
First Line	:	2889 NEWPORT AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-3329
Country	:	US
Telephone Number	:	913-568-7939
Fax Number	:

Provider Business Practice Location Address
First Line	:	2889 NEWPORT AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-3329
Country	:	US
Telephone Number	:	913-568-7939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	11/03/2025

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Directions to “ CASSANDRA BOX ” Practice Location

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