Basic Information
| Provider Information | |||||||||
| NPI: | 1811175896 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUR HOMES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2039 Q ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685033643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024742121 | ||||||||
| FaxNumber: | 4024779752 | ||||||||
| Practice Location | |||||||||
| Address1: | 2039 Q ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LINCOLN | ||||||||
| State: | NE | ||||||||
| PostalCode: | 685033643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4024742121 | ||||||||
| FaxNumber: | 4024779752 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2008 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | OSHEA | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | HEPBURN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4024742121 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LIMHP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3104A0625X | ALF171 | NE | Y | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 10025513400 | 05 | NE | MEDICAID | 10025314600 | 05 | NE | MEDICAID |