Healthcare Provider Details

I. General information

NPI: 1255824256
Provider Name (Legal Business Name): OMEGA HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 SIMS ST STE 15
DICKINSON ND
58601-5116
US

IV. Provider business mailing address

224 7TH AVE W # 2
DICKINSON ND
58601-4926
US

V. Phone/Fax

Practice location:
  • Phone: 701-595-9661
  • Fax:
Mailing address:
  • Phone: 701-595-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number23746
License Number StateND

VIII. Authorized Official

Name: CLOVIS HABIMANA
Title or Position: MEMBER
Credential:
Phone: 252-455-7533