Individual provider · Type 1 NPI

Egnonche Mitchozounnou

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Omaha, NE

NPI number 1124987102 Active

Practice location

1805 N 73rd St
Omaha, NE 68114-1905

Call (402) 557-8583 Map

Mailing address

10506 Laurel Ave
Omaha, NE 68134-1055

Specialties and licenses

TaxonomyCodeLicense
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary 320900000XNone listed

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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About NPI 1124987102

Egnonche Mitchozounnou's National Provider Identifier is 1124987102, issued on Jan 16, 2026. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Omaha, NE. The record was last updated on Jan 16, 2026.