Provider Demographics
NPI:1366339947
Name:JOSEPH, IDA
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:
Last Name:JOSEPH
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 1:11130 JONES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3347
Mailing Address - Country:US
Mailing Address - Phone:310-994-7464
Mailing Address - Fax:
Practice Address - Street 1:11130 JONES ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-3347
Practice Address - Country:US
Practice Address - Phone:310-994-7464
Practice Address - Fax:310-994-7464
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant