Healthcare Provider Details

I. General information

NPI: 1801494588
Provider Name (Legal Business Name): OMNI SOUTH HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/28/2020
Certification Date: 10/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8225 YMCA PLAZA DR
BATON ROUGE LA
70810-0922
US

IV. Provider business mailing address

7515 JEFFERSON HWY # 155
BATON ROUGE LA
70806-8308
US

V. Phone/Fax

Practice location:
  • Phone: 225-921-5697
  • Fax: 913-222-1693
Mailing address:
  • Phone: 225-921-5697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: ADRIENNE CLARK ALLEN
Title or Position: OWNER
Credential: CNP
Phone: 225-281-4485