MEDICARE: BENJILA WILLOUGHBY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility
2	373H00000X	Day Training/Habilitation Specialist
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1891540225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJILA WILLOUGHBY

Provider Business Mailing Address
First Line	:	4924 EMMET ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-3656
Country	:	US
Telephone Number	:	402-594-9578
Fax Number	:

Provider Business Practice Location Address
First Line	:	4924 EMMET ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-3656
Country	:	US
Telephone Number	:	402-739-2386
Fax Number	:

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

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	04/19/2024

Similar Medicare Providers

1518959295 — DR. BONNIE JEAN LEES MD
Practice Location Address:

8200 DODGE STREET , CHILDREN'S HOSPITAL & MEDICARE CENTER
OMAHA, NE
68114-4113

Practice Phone: 402-955-6140
Practice Fax: 402-955-3398

1205788395 — CARLA FORD
Practice Location Address:

3445 N 106TH PLZ APT 1708
OMAHA, NE
68134-3656

Practice Phone: 402-906-0269
Practice Fax:

1295686756 — QUIREESE HUDSON
Practice Location Address:

4120 N 61ST ST
OMAHA, NE
68104-2623

Practice Phone: 402-515-2572
Practice Fax:

1215888748 — KENNETH GREGORY
Practice Location Address:

6623 KANSAS AVE
OMAHA, NE
68104-1033

Practice Phone: 531-210-7244
Practice Fax:

1659223196 — MOE M OO
Practice Location Address:

2506 N 63RD ST
OMAHA, NE
68104-4028

Practice Phone: 402-320-5319
Practice Fax:

1265113641 — KELLY JO BERGEVIN APRN
Practice Location Address:

6320 N. 70TH PLZ
OMAHA, NE
68104-1074

Practice Phone: 402-573-3761
Practice Fax: 402-573-3780

Directions to “ BENJILA WILLOUGHBY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.