Healthcare Provider Details

I. General information

NPI: 1548109127
Provider Name (Legal Business Name): MATI HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 03/27/2026
Certification Date: 03/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 N 38TH ST
OMAHA NE
68111-4005
US

IV. Provider business mailing address

1704 N 38TH ST
OMAHA NE
68111-4005
US

V. Phone/Fax

Practice location:
  • Phone: 402-401-9325
  • Fax: 402-401-9325
Mailing address:
  • Phone: 402-401-9325
  • Fax: 402-401-9325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. GEMMECHIS KITAW MOKONON
Title or Position: OWNER
Credential:
Phone: 402-401-9325