=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538393475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMEGA HEALTH CARE SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 05/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1021 LAKE SHORE DR
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-223-7389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1021 LAKE SHORE DR
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-223-7389
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. BENEDICT CHUCK MORDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-223-7389
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R2724
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------