Provider Demographics
NPI:1073847844
Name:HOME RESPIRATORY WITH HEART
Entity type:Organization
Organization Name:HOME RESPIRATORY WITH HEART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:JESUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-614-4622
Mailing Address - Street 1:7602 PARK DR STE B
Mailing Address - Street 2:
Mailing Address - City:RALSTON
Mailing Address - State:NE
Mailing Address - Zip Code:68127-3944
Mailing Address - Country:US
Mailing Address - Phone:402-614-4622
Mailing Address - Fax:402-614-4726
Practice Address - Street 1:7602 PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:RALSTON
Practice Address - State:NE
Practice Address - Zip Code:68127-3944
Practice Address - Country:US
Practice Address - Phone:402-614-4622
Practice Address - Fax:402-614-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-28
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025827000Medicaid
NE6403260001Medicare NSC