Provider Demographics
NPI:1053126441
Name:AIDEGO, HENRIETTE
Entity type:Individual
Prefix:
First Name:HENRIETTE
Middle Name:
Last Name:AIDEGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 N 73RD ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-1905
Mailing Address - Country:US
Mailing Address - Phone:402-557-8583
Mailing Address - Fax:
Practice Address - Street 1:7403 BRAUN ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-2791
Practice Address - Country:US
Practice Address - Phone:402-218-6231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities