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General NPI Number Information
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NPI Number | 1528880754
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Entity Type | Organization
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Legal Business Name | SAVANNAH TRAILS LLC
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 521 S 69TH ST
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City | OMAHA
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State | NE
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Zip | 68106-1001
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Country | US
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Telephone | 402-284-8805
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 45139
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City | OMAHA
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State | NE
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Zip | 68145-0139
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Country | US
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Telephone | 402-284-8805
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. ANTHONY O EVERO
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Credential |
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Telephone | 202-489-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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