Organization
OMAHA COUNTRYHOUSE LLC
Active
Other names
Omaha CountryHouse LLC
Organization subpart
No
Provider details
NPI number
Authorized official
STACY L RANDELS (VP)
(531) 800-3364
Entity
Organization
Contact information
Practice address
5030 S 155TH ST, OMAHA, NE 68137-5002
(402) 964-2060
Mailing address
5030 S 155TH ST, OMAHA, NE 68137-5002
(402) 964-2060
Taxonomy
Speciality
Code
Description
License number
State
311500000X
Alzheimer Center (Dementia Center)
Primary
2988
NE
Other
Enumeration date
09/10/2014
Last updated
05/22/2025
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