# IMMANUEL LONG TERM CARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** The Lighthouse at Lakeside Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811335839
- **Authorized official:** MR. ERIC N GURLEY (PRESIDENT AND CEO)
- **Authorized official phone:** (402) 829-2900

## Contact information

- **Practice address:** 17600 ARBOR ST, OMAHA, NE 68130-4682
- **Practice address phone:** (402) 829-9070
- **Practice address fax:** (402) 829-9071
- **Mailing address:** 1044 N 115TH ST STE 500, OMAHA, NE 68154-4410
- **Mailing address phone:** (402) 829-2931
- **Mailing address fax:** (402) 829-2939

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | — | NULL | — |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 06/12/2013
- **Last updated:** 05/30/2019