Healthcare Provider Details

I. General information

NPI: 1790922995
Provider Name (Legal Business Name): OMEGA CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2009
Last Update Date: 01/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 ESSINGTON CT
BOWIE MD
20716-3246
US

IV. Provider business mailing address

3502 ESSINGTON CT
BOWIE MD
20716-3246
US

V. Phone/Fax

Practice location:
  • Phone: 240-386-7621
  • Fax: 240-206-9578
Mailing address:
  • Phone: 240-386-7621
  • Fax: 240-206-9578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberD12864559
License Number StateMD

VIII. Authorized Official

Name: DR. RHODA ELOHO ODIVBRI
Title or Position: PRESIDENT
Credential:
Phone: 240-386-7621