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General NPI Number Information
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NPI Number | 1740463736
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Entity Type | Organization
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Legal Business Name | OMNIA CUM DEO CORP
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Dates
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Enumeration Date | 12/12/2007
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Last Update Date | 12/12/2007
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Provider Practice Location Address
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Address Line | 1745 FOREST DR
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City | INVERNESS
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State | FL
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Zip | 34453-3832
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Country | US
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Telephone | 352-726-5466
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Fax | 352-726-3529
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Provider Business Mailing Address
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Address Line | 1745 FOREST DR
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City | INVERNESS
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State | FL
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Zip | 34453-3832
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Country | US
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Telephone | 352-726-5466
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Fax | 352-726-3526
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. MARY M ELLIS
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Credential | LPN
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Telephone | 352-726-5466
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 5778
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License Number State | FL
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