Provider Demographics
NPI:1285421503
Name:EMBRACING HEART SUPPORTIVE SERVICES
Entity type:Organization
Organization Name:EMBRACING HEART SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QA DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACKSTALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-806-2642
Mailing Address - Street 1:11069 I ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1207
Mailing Address - Country:US
Mailing Address - Phone:402-201-7719
Mailing Address - Fax:
Practice Address - Street 1:11069 I ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1207
Practice Address - Country:US
Practice Address - Phone:402-201-7719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty