Healthcare Provider Details

I. General information

NPI: 1649618661
Provider Name (Legal Business Name): IMMANUEL LONG TERM CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6798 N 67TH PLAZA
OMAHA NE
68152-2117
US

IV. Provider business mailing address

1044 N 115TH ST STE 500
OMAHA NE
68154-4410
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-2595
  • Fax:
Mailing address:
  • Phone: 402-829-2900
  • Fax: 402-829-2939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC N GURLEY
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 402-829-2900