Healthcare Provider Details

I. General information

NPI: 1962059956
Provider Name (Legal Business Name): OMGHEALTHCAREAGENCYLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7676 HILLMONT ST STE 290P
HOUSTON TX
77040-6425
US

IV. Provider business mailing address

7676 HILLMONT ST STE 290P
HOUSTON TX
77040-6425
US

V. Phone/Fax

Practice location:
  • Phone: 832-831-6683
  • Fax: 832-831-6687
Mailing address:
  • Phone: 832-831-6683
  • Fax: 832-831-6687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DORIS J DAVIS
Title or Position: ALT.ADMIMISTRATIVE
Credential:
Phone: 346-339-9819