MEDICARE: ROSALIE LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
3	385HR2065X	Child Physical Disabilities Respite Care
4	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1740752195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSALIE LLC

Provider Business Mailing Address
First Line	:	11605 WEST DODGE RD, STE 4
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2566
Country	:	US
Telephone Number	:	402-979-7770
Fax Number	:	402-979-7770

Provider Business Practice Location Address
First Line	:	11605 WEST DODGE RD, STE 4
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68154-2566
Country	:	US
Telephone Number	:	402-979-7770
Fax Number	:	402-979-7770

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BIENVENU YEMALIN ADDAH
Credential	:
Telephone Number	:	402-979-7770

Provider Enumeration Date	:	12/26/2018
Last Update Date	:	05/08/2025

Similar Medicare Providers

1518959295 — DR. BONNIE JEAN LEES MD
Practice Location Address:

8200 DODGE STREET , CHILDREN'S HOSPITAL & MEDICARE CENTER
OMAHA, NE
68114-4113

Practice Phone: 402-955-6140
Practice Fax: 402-955-3398

1811850472 — DAYANA BALBUENA PEREZ
Practice Location Address:

11605 W DODGE RD
OMAHA, NE
68154-2566

Practice Phone: 402-979-7770
Practice Fax:

1447576459 — JAYNA BACZWASKI
Practice Location Address:

11605 W DODGE RD STE 4
OMAHA, NE
68154-2566

Practice Phone: 402-881-6050
Practice Fax:

1144767245 — JCB THERAPY LLC
Practice Location Address:

11605 W DODGE RD STE 4
OMAHA, NE
68154-2566

Practice Phone: 402-881-6050
Practice Fax: 531-999-2356

1528659117 — KATELYN PANKONIN
Practice Location Address:

11605 W DODGE RD STE 4
OMAHA, NE
68154-2566

Practice Phone: 402-256-7360
Practice Fax:

1568056620 — MEGAN WOLFF COUNSELING
Practice Location Address:

11605 W DODGE RD STE 4
OMAHA, NE
68154-2566

Practice Phone: 402-515-4140
Practice Fax:

Directions to “ROSALIE LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.