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General NPI Number Information
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NPI Number | 1134436272
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Entity Type | Organization
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Legal Business Name | BOMAH SERVICES INC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 09/10/2010
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Provider Practice Location Address
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Address Line | 7756 TANBIER DRIVE
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City | ORLANDO
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State | FL
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Zip | 32818
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Country | US
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Telephone | 407-232-3771
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Fax | 407-293-9615
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Provider Business Mailing Address
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Address Line | 7756 TANBIER DRIVE
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City | ORLANDO
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State | FL
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Zip | 32818
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Country | US
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Telephone | 407-232-3771
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Fax | 407-293-9615
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH E BOMAH
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Credential |
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Telephone | 407-232-3771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 321808
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 692805696
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License Number State |
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