MEDICARE: INFINIA AT OMAHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	264602	NE

General Provider Information

NPI Number	:	1326045998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INFINIA AT OMAHA

Provider Business Mailing Address
First Line	:	3110 SCOTT CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-2631
Country	:	US
Telephone Number	:	402-455-6636
Fax Number	:	402-455-0407

Provider Business Practice Location Address
First Line	:	3110 SCOTT CIR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68112-2631
Country	:	US
Telephone Number	:	402-455-6636
Fax Number	:	402-455-0407

Authorized Official
Title or Position	:	OWNER
Name	:	SCOTT ROBERTSON
Credential	:
Telephone Number	:	801-295-8000

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/22/2020

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