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General NPI Number Information
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NPI Number | 1831499805
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Entity Type | Organization
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Legal Business Name | OMNI PRIVATE DUTY, LLC
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 25932 DEQUINDRE RD SUITE B
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City | WARREN
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State | MI
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Zip | 48091-1071
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Country | US
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Telephone | 586-759-9525
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Fax | 586-582-0184
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Provider Business Mailing Address
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Address Line | 25932 DEQUINDRE RD SUITE B
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City | WARREN
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State | MI
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Zip | 48091-1071
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Country | US
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Telephone | 586-759-9525
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Fax | 586-582-0184
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Authorized Official
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Title or Position | DIRECTOR OF NURSING/OWNER
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Name | MRS. LUDA BRAND
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Credential | RN
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Telephone | 586-759-9525
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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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