Healthcare Provider Details

I. General information

NPI: 1891307963
Provider Name (Legal Business Name): LR MOORE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5421 N 103RD ST STE 401
OMAHA NE
68134-1010
US

IV. Provider business mailing address

5421 N 103RD ST STE 401
OMAHA NE
68134-1010
US

V. Phone/Fax

Practice location:
  • Phone: 402-393-2525
  • Fax: 402-393-2441
Mailing address:
  • Phone: 402-393-2525
  • Fax: 402-393-2441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: LAWANDA ROCHELLE MOORE
Title or Position: CEO
Credential:
Phone: 402-393-2525