Provider Demographics
NPI:1679385488
Name:AGNES ANNA GROUP HOME LLC
Entity type:Organization
Organization Name:AGNES ANNA GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NDUMU
Authorized Official - Middle Name:ANUH
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-871-7869
Mailing Address - Street 1:806 HOGAN DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-2121
Mailing Address - Country:US
Mailing Address - Phone:402-871-7869
Mailing Address - Fax:531-484-2788
Practice Address - Street 1:806 HOGAN DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-2121
Practice Address - Country:US
Practice Address - Phone:402-871-7869
Practice Address - Fax:531-484-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services