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General NPI Number Information
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NPI Number | 1760201867
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Entity Type | Organization
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Legal Business Name | SUCCOR HOME CARE LLC
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 7805 L ST STE 140
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City | OMAHA
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State | NE
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Zip | 68127-1870
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Country | US
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Telephone | 402-331-5814
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Fax |
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Provider Business Mailing Address
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Address Line | 7805 L ST STE 140
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City | OMAHA
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State | NE
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Zip | 68127-1870
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | TERRANCE TILSON
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Credential |
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Telephone | 531-375-1013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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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 | 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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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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