MEDICARE: OMNIACARE 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	251G00000X	Community Based Hospice Care Agency

General Provider Information

NPI Number	:	1902402894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNIACARE LLC

Provider Business Mailing Address
First Line	:	1977 E 2590 SOUTH CIR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-7024
Country	:	US
Telephone Number	:	435-467-8201
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 FALCON RIDGE PKWY STE 101
Second Line	:
City	:	MESQUITE
State	:	NV
Zip	:	89027-8879
Country	:	US
Telephone Number	:	702-849-0585
Fax Number	:	702-849-0614

Authorized Official
Title or Position	:	PART OWNER
Name	:	VANESSA DAWN BARBEN
Credential	:	RN
Telephone Number	:	435-467-8201

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	10/04/2021

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