Healthcare Provider Details

I. General information

NPI: 1104646140
Provider Name (Legal Business Name): PATRON SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 JONES ST STE 211
OMAHA NE
68102-3218
US

IV. Provider business mailing address

12020 SHAMROCK PLZ STE 200
OMAHA NE
68154-3537
US

V. Phone/Fax

Practice location:
  • Phone: 402-800-7759
  • Fax: 402-585-0182
Mailing address:
  • Phone: 402-698-0098
  • Fax: 402-585-0182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HAJI A SALAD
Title or Position: CEO
Credential:
Phone: 402-698-0098