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General NPI Number Information
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NPI Number | 1801049788
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Entity Type | Organization
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Legal Business Name | OMETTA, LLC
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 3140 HARBOR LN N SUITE 250
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City | PLYMOUTH
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State | MN
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Zip | 55447-5126
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Country | US
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Telephone | 763-551-1109
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Fax |
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Provider Business Mailing Address
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Address Line | 3140 HARBOR LN N SUITE 250
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City | PLYMOUTH
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State | MN
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Zip | 55447-5126
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Country | US
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Telephone | 763-551-1109
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SEARCY MILES CURRIN
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Credential |
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Telephone | 763-551-1123
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | R173285-2
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License Number State | MN
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