Healthcare Provider Details

I. General information

NPI: 1205409091
Provider Name (Legal Business Name): OMEGA CARE HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2021
Last Update Date: 11/01/2024
Certification Date: 08/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

842 N FAIR OAKS AVE UNIT 150
PASADENA CA
91103-3052
US

IV. Provider business mailing address

842 N FAIR OAKS AVE UNIT 150
PASADENA CA
91103-3046
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-4280
  • Fax: 888-597-9838
Mailing address:
  • Phone: 888-663-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALBERT VILLAVICENCIO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 888-663-4280