Healthcare Provider Details

I. General information

NPI: 1205758562
Provider Name (Legal Business Name): OMAHA ONE OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 S 40TH ST
OMAHA NE
68105-1827
US

IV. Provider business mailing address

915 BENNETTS MILLS RD UNIT 1041
JACKSON NJ
08527-8023
US

V. Phone/Fax

Practice location:
  • Phone: 402-342-2015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ABRAHAM SMILOW
Title or Position: MANAGER
Credential:
Phone: 917-543-4391