Individual
RA TET
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4819 N 66TH ST APT 133, OMAHA, NE 68104-1938
(518) 229-9231
Mailing address
4819 N 66TH ST APT 133, OMAHA, NE 68104-1938
(518) 229-9231
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
05/14/2025
Last updated
05/14/2025
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