Healthcare Provider Details

I. General information

NPI: 1497277933
Provider Name (Legal Business Name): OMNIV HEALTH SYSTEMS LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2017
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 SOUTHWEST FWY STE 515
HOUSTON TX
77027
US

IV. Provider business mailing address

810 DAKOTA ST
SOUTH HOUSTON TX
77587-3012
US

V. Phone/Fax

Practice location:
  • Phone: 713-732-4174
  • Fax: 713-960-1122
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. COURTNEY ALLEN JACOBS I
Title or Position: MANAGING MEMBER/DIRECTOR
Credential:
Phone: 713-732-4174