Individual
CHIDAE SEVILLE GORDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6656 DECATUR ST, OMAHA, NE 68104-4641
(469) 358-4740
Mailing address
6656 DECATUR ST, OMAHA, NE 68104-4641
(469) 358-4740
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/07/2025
Last updated
03/12/2025
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