Provider Demographics
NPI:1598180390
Name:NEBRASKA LIII, LLC
Entity Type:Organization
Organization Name:NEBRASKA LIII, LLC
Other - Org Name:EASTERN NEBRASKA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MELANCON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-979-3680
Mailing Address - Street 1:8710 F ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1527
Mailing Address - Country:US
Mailing Address - Phone:402-397-8330
Mailing Address - Fax:402-331-2207
Practice Address - Street 1:8710 F ST
Practice Address - Street 2:SUITE 118
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1527
Practice Address - Country:US
Practice Address - Phone:402-397-8330
Practice Address - Fax:402-331-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261011251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
287109Medicare Oscar/Certification