MEDICARE: NEBRASKA LIII, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	261011	NE

General Provider Information

NPI Number	:	1598180390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEBRASKA LIII, LLC

Provider Business Mailing Address
First Line	:	8710 F ST
Second Line	:	SUITE 118
City	:	OMAHA
State	:	NE
Zip	:	68127-1527
Country	:	US
Telephone Number	:	402-397-8330
Fax Number	:	402-331-2207

Provider Business Practice Location Address
First Line	:	8710 F ST
Second Line	:	SUITE 118
City	:	OMAHA
State	:	NE
Zip	:	68127-1527
Country	:	US
Telephone Number	:	402-397-8330
Fax Number	:	402-331-2207

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. JAMES MELANCON
Credential	:
Telephone Number	:	952-979-3680

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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