Provider Demographics
NPI:1225833239
Name:LOPEZ RIVERA, RODOLFO M (SHARED LIVING PROVID)
Entity type:Individual
Prefix:
First Name:RODOLFO
Middle Name:M
Last Name:LOPEZ RIVERA
Suffix:
Gender:M
Credentials:SHARED LIVING PROVID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 N KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-3929
Mailing Address - Country:US
Mailing Address - Phone:402-303-2777
Mailing Address - Fax:
Practice Address - Street 1:916 N KANSAS AVE
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-3929
Practice Address - Country:US
Practice Address - Phone:402-303-2777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant