Active NPI
Angelia D Henderson
- Skilled Nursing Facility
- Omaha, NE
National Provider Identifier
1821345471
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 324
- Practice address
- 2525 S. 135TH Ave
Omaha, NE 68144 - Phone
- (402) 333-2304
- Fax
- (402) 333-1269
- NPI assigned
- Aug 13, 2012
- Last updated
- Aug 13, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 324 | NE | Primary |
Addresses
Primary practice location
2525 S. 135TH Ave
Omaha, NE 68144
Mailing address
5708 N 167TH Ave Circle
Omaha, NE 68116
Phone (402) 681-9469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 324 | NE | MD | Skilled Nursing Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1344816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1344816000000",
"number": "1821345471",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5708 N 167TH AVE CIRCLE",
"city": "OMAHA",
"state": "NE",
"postal_code": "68116",
"telephone_number": "402-681-9469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2525 S. 135TH AVE",
"city": "OMAHA",
"state": "NE",
"postal_code": "68144",
"telephone_number": "402-333-2304",
"fax_number": "402-333-1269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERSON",
"first_name": "ANGELIA",
"middle_name": "D",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-08-13",
"last_updated": "2012-08-13",
"status": "A"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NE",
"license": "324",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.