Healthcare Provider Details

I. General information

NPI: 1497574594
Provider Name (Legal Business Name): SUCCOR HOMEHEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7805 L ST STE 140
OMAHA NE
68127-1870
US

IV. Provider business mailing address

7805 L ST STE 140
OMAHA NE
68127-1870
US

V. Phone/Fax

Practice location:
  • Phone: 402-331-5814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: TERRANCE TILSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 402-609-9544