Provider Demographics
NPI:1912748286
Name:AEGIS NEBRASKA LLC
Entity type:Organization
Organization Name:AEGIS NEBRASKA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-514-5646
Mailing Address - Street 1:8214 F ST STE A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1740
Mailing Address - Country:US
Mailing Address - Phone:402-331-2273
Mailing Address - Fax:402-933-4255
Practice Address - Street 1:8214 F ST STE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1740
Practice Address - Country:US
Practice Address - Phone:402-331-2273
Practice Address - Fax:402-933-4255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AEGIS NEBRASKA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-03
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based