Provider Demographics
NPI:1679502397
Name:DIVERSIFIED HEALTHCARE, INC.
Entity type:Organization
Organization Name:DIVERSIFIED HEALTHCARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, ADMINISTRATOR, DHCS
Authorized Official - Prefix:MISS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:402-392-1818
Mailing Address - Street 1:5332 S 138TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2974
Mailing Address - Country:US
Mailing Address - Phone:402-392-1818
Mailing Address - Fax:402-392-0167
Practice Address - Street 1:5332 S 138TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2974
Practice Address - Country:US
Practice Address - Phone:402-392-1818
Practice Address - Fax:402-392-0167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261012251E00000X
NEHHA201501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE287027Medicare Oscar/Certification