Healthcare Provider Details

I. General information

NPI: 1528880754
Provider Name (Legal Business Name): SAVANNAH TRAILS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 S 69TH ST
OMAHA NE
68106-1001
US

IV. Provider business mailing address

PO BOX 45139
OMAHA NE
68145-0139
US

V. Phone/Fax

Practice location:
  • Phone: 402-284-8805
  • Fax:
Mailing address:
  • Phone: 402-284-8805
  • 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 Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MR. ANTHONY O EVERO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-489-9656