Healthcare Provider Details

I. General information

NPI: 1639870967
Provider Name (Legal Business Name): OMASHOMECARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2023
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 W CHELTENHAM AVE
PHILADELPHIA PA
19120-1027
US

IV. Provider business mailing address

130 W CHELTENHAM AVE
PHILADELPHIA PA
19120-1027
US

V. Phone/Fax

Practice location:
  • Phone: 919-633-4447
  • Fax:
Mailing address:
  • Phone: 919-633-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHIDINMA MAPP
Title or Position: MRS
Credential:
Phone: 919-633-4447