Healthcare Provider Details

I. General information

NPI: 1407719347
Provider Name (Legal Business Name): TODD SIMMONS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3016 N 48TH AVE
OMAHA NE
68104-3772
US

IV. Provider business mailing address

7200 S 84TH ST
LA VISTA NE
68128-2115
US

V. Phone/Fax

Practice location:
  • Phone: 531-375-6099
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: