Healthcare Provider Details

I. General information

NPI: 1467139998
Provider Name (Legal Business Name): OMNI CARE CONSULTING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 HASSERT BLVD, STE 135, #681
NAPERVILLE IL
60564
US

IV. Provider business mailing address

2735 HASSERT BLVD, STE 135, #681
NAPERVILLE IL
60564
US

V. Phone/Fax

Practice location:
  • Phone: 630-863-0722
  • Fax:
Mailing address:
  • Phone: 630-863-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AYODEJI ADEGOYE
Title or Position: CEO
Credential:
Phone: 773-983-9892