Provider Demographics
NPI:1083425672
Name:PUH-PO HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:PUH-PO HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SEPTEMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:OO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-235-1065
Mailing Address - Street 1:8417 GIRARD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1910 S 44TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-2845
Practice Address - Country:US
Practice Address - Phone:402-739-2384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care