Omaha Countryhouse LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

2988 Issued in NE

Legal business name

OMAHA COUNTRYHOUSE LLC

Doing business as

Omaha CountryHouse LLC

Practice address

5030 S 155TH St
Omaha, NE 68137-5002

Phone

(402) 964-2060

NPI assigned

Sep 10, 2014

Last updated

May 22, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stacy L Randels

Title

VP

Phone

(531) 800-3364

Specialties & licenses 1

Addresses

Other names 1

• Omaha CountryHouse LLC Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747872000000",
    "number": "1093116998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 S 155TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681375002",
            "telephone_number": "402-964-2060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5030 S 155TH ST",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681375002",
            "telephone_number": "402-964-2060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMAHA COUNTRYHOUSE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-09-10",
        "last_updated": "2025-05-22",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "RANDELS",
        "authorized_official_first_name": "STACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "531-800-3364"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NE",
            "license": "2988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Omaha CountryHouse LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Omaha CountryHouse LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Alzheimer Center (Dementia Center) in Omaha, NE
• Providers in Omaha, NE by specialty
• Alzheimer Center (Dementia Center) in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.