Healthcare Provider Details

I. General information

NPI: 1912944810
Provider Name (Legal Business Name): OMRO HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 09/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 GRANT AVE
OMRO WI
54963-1342
US

IV. Provider business mailing address

500 GRANT AVE
OMRO WI
54963-1342
US

V. Phone/Fax

Practice location:
  • Phone: 920-685-2755
  • Fax: 920-685-0599
Mailing address:
  • Phone: 920-685-2755
  • Fax: 920-685-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3241
License Number StateWI

VIII. Authorized Official

Name: WILLIAM R. WATSON II
Title or Position: MANAGER
Credential:
Phone: 920-685-2755