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General NPI Number Information
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NPI Number | 1427674670
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Entity Type | Organization
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Legal Business Name | OMNI SENIOR CARE SOLUTIONS
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 06/24/2020
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Provider Practice Location Address
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Address Line | 4412 ASHBURY LN
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City | MANSFIELD
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State | TX
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Zip | 76063-6702
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Country | US
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Telephone | 904-536-1467
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Fax |
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Provider Business Mailing Address
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Address Line | 3540 E BROAD ST # 141
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City | MANSFIELD
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State | TX
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Zip | 76063-5633
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Country | US
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Telephone | 904-536-1467
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | GEORGINA FOMENKY
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Credential |
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Telephone | 904-536-1467
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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