MEDICARE: PREMIUM HOMECARE OMAHA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	372600000X	Adult Companion
2	374U00000X	Home Health Aide
3	376J00000X	Homemaker
4	372500000X	Chore Provider

General Provider Information

NPI Number	:	1760335970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIUM HOMECARE OMAHA

Provider Business Mailing Address
First Line	:	14814 RUGGLES ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-1419
Country	:	US
Telephone Number	:	682-465-9797
Fax Number	:	682-465-9797

Provider Business Practice Location Address
First Line	:	14814 RUGGLES ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68116-1419
Country	:	US
Telephone Number	:	682-465-9797
Fax Number	:	682-465-9797

Authorized Official
Title or Position	:	OWNER
Name	:	ARMELLE DESIREE YONGABI
Credential	:
Telephone Number	:	682-465-9797

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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Directions to “PREMIUM HOMECARE OMAHA ” Practice Location

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