MEDICARE: PAC HOME CARE, LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1679399851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAC HOME CARE, LLC

Provider Business Mailing Address
First Line	:	7925 MEREDITH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-3344
Country	:	US
Telephone Number	:	402-276-6892
Fax Number	:

Provider Business Practice Location Address
First Line	:	7925 MEREDITH AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-3344
Country	:	US
Telephone Number	:	402-276-6892
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JENNIFER K TOLSTON
Credential	:
Telephone Number	:	402-276-6892

Provider Enumeration Date	:	12/03/2024
Last Update Date	:	12/03/2024

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Directions to “PAC HOME CARE, LLC ” Practice Location

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