Healthcare Provider Details

I. General information

NPI: 1235821364
Provider Name (Legal Business Name): OM HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 STREET ROAD
BENSALEM PA
19020-2816
US

IV. Provider business mailing address

1941 STREET ROAD
BENSALEM PA
19020-2816
US

V. Phone/Fax

Practice location:
  • Phone: 267-994-8688
  • Fax:
Mailing address:
  • Phone: 267-994-8688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BRIJESH PATEL
Title or Position: PRESIDENT
Credential:
Phone: 267-994-8688