Kossivi Nyagblodjro
Individual provider Active NPI Adult Companion · Omaha, NE
NPI 1902603855 · NPPES record last updated Feb 27, 2025
Key facts
- NPI
- 1902603855
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Adult Companion 372600000X
- Practice address
- 11529 Oak Cir
Omaha, NE 68144-4409 - Phone
- (402) 452-8748
- NPI assigned
- Feb 27, 2025
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prime Home Developmental Disabilities Services, Inc | Past |
Accepting new patients | |
| Prime Home Developmental Disabilities Services, Inc | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | |||
| Child Intellectual and/or Developmental Disabilities Respite Care | 385HR2060X | |||
| Adult Companion | 372600000X | Yes |
Addresses
Primary practice location
11529 Oak Cir
Omaha, NE 68144-4409
Mailing address
6818 Grover St Ste 200
Omaha, NE 68106-3632
Phone (402) 932-0072
Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.