=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366247496
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOTHER OF MERCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2025
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2110 FLETCHER AVE
-----------------------------------------------------
City | LINCOLN
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68521-5839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-221-3586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6433 CENTENNIAL RD
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68157-2199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-221-3586
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | RALPH C ANIEKE
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 505-221-3586
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------