Healthcare Provider Details

I. General information

NPI: 1225837024
Provider Name (Legal Business Name): NEBRASKA INDEPENDENT LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 S 84TH ST STE 100
OMAHA NE
68127-4100
US

IV. Provider business mailing address

8903 N 161ST AVE
BENNINGTON NE
68007-6417
US

V. Phone/Fax

Practice location:
  • Phone: 501-791-6086
  • Fax:
Mailing address:
  • Phone: 501-791-6086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral 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: NAPELIS MISSI TIDJANI
Title or Position: DIRECTOR
Credential:
Phone: 501-791-6086