=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659998557
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OM HARI LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2020
-----------------------------------------------------
Last Update Date | 06/26/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 BUSINESS PKWY # A-C
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-616-3569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 BUSINESS PKWY # A-C
-----------------------------------------------------
City | PIEDMONT
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29673-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-616-3569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. BRIJESH PATEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 848-209-6868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------