Healthcare Provider Details

I. General information

NPI: 1679050033
Provider Name (Legal Business Name): O&A HOMECARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2307 HERMITAGE CT APT 709
INDIANAPOLIS IN
46224
US

IV. Provider business mailing address

2307 HERMITAGE CT APT 709
INDIANAPOLIS IN
46224-3845
US

V. Phone/Fax

Practice location:
  • Phone: 718-710-2839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. OLUWAFUNMILAYO BOSEDE BOMIDE
Title or Position: OWNER
Credential: RN
Phone: 347-352-4292