Healthcare Provider Details

I. General information

NPI: 1770243990
Provider Name (Legal Business Name): ODA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S 25TH ST
OMAHA NE
68131-3601
US

IV. Provider business mailing address

6829 N 72ND ST
OMAHA NE
68122-1723
US

V. Phone/Fax

Practice location:
  • Phone: 701-500-6189
  • Fax:
Mailing address:
  • Phone: 701-500-6189
  • Fax:

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 Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED ABDULAIZZ
Title or Position: MANGER
Credential: LAB TECHNOLOGIST
Phone: 701-500-6189