MEDICARE: CALEB DIGIACOMO

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

General Provider Information

NPI Number	:	1619771524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALEB DIGIACOMO

Provider Business Mailing Address
First Line	:	7404 JAMES AVE
Second Line	:
City	:	LA VISTA
State	:	NE
Zip	:	68128-2612
Country	:	US
Telephone Number	:	402-973-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	4611 S 96TH ST STE 101
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1220
Country	:	US
Telephone Number	:	402-506-9368
Fax Number	:

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

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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Directions to “ CALEB DIGIACOMO ” Practice Location

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