MEDICARE: OMNI HOME HEALTH - JACKSONVILLE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	299991616	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467446203
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI HOME HEALTH - JACKSONVILLE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 51266
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70505-1266
Country	:	US
Telephone Number	:	337-233-1307
Fax Number	:	337-233-5764

Provider Business Practice Location Address
First Line	:	2765 REBECCA LN STE A&B
Second Line	:
City	:	ORANGE CITY
State	:	FL
Zip	:	32763-8326
Country	:	US
Telephone Number	:	386-775-0164
Fax Number	:	386-775-0760

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSHUA L. PROFFITT
Credential	:
Telephone Number	:	337-233-1307

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	06/13/2023

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