MEDICARE: LIEBE'S LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	253Z00000X	In Home Supportive Care Agency
3	311ZA0620X	Adult Care Home Facility
4	315P00000X	Intellectual Disabilities Intermediate Care Facility
5	385HR2065X	Child Physical Disabilities Respite Care
6	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1467260299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIEBE'S LLC

Provider Business Mailing Address
First Line	:	8790 F ST STE 212
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1534
Country	:	US
Telephone Number	:	402-208-1939
Fax Number	:

Provider Business Practice Location Address
First Line	:	8790 F ST STE 212
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68127-1534
Country	:	US
Telephone Number	:	402-208-1939
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	EYA MECONOVINO DJISSENOU
Credential	:
Telephone Number	:	402-208-1939

Provider Enumeration Date	:	12/26/2024
Last Update Date	:	12/26/2024

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Directions to “LIEBE'S LLC ” Practice Location

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