Provider Demographics
NPI:1225103021
Name:OMAHA NURSING HOME INC
Entity Type:Organization
Organization Name:OMAHA NURSING HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NIJOLA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRIGAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR #1352
Authorized Official - Phone:402-733-7200
Mailing Address - Street 1:4835 SO 49 ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68117-2002
Mailing Address - Country:US
Mailing Address - Phone:402-733-7200
Mailing Address - Fax:
Practice Address - Street 1:4835 S 49TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68117-2002
Practice Address - Country:US
Practice Address - Phone:402-733-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE264013314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========Medicaid
NE=========Medicaid