Provider Demographics
NPI:1790285005
Name:MADONNA REHABILITATION HOSPITAL
Entity Type:Organization
Organization Name:MADONNA REHABILITATION HOSPITAL
Other - Org Name:MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:DONGILLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:402-413-3000
Mailing Address - Street 1:5401 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-2150
Mailing Address - Country:US
Mailing Address - Phone:402-413-3000
Mailing Address - Fax:402-413-4488
Practice Address - Street 1:17500 BURKE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68118-2244
Practice Address - Country:US
Practice Address - Phone:402-401-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100264690-00Medicaid