Provider Demographics
NPI:1023027026
Name:OMEGA PROVIDER SERVICES INC
Entity Type:Organization
Organization Name:OMEGA PROVIDER SERVICES INC
Other - Org Name:OMEGA HOME HEALTHCARE AGENCY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NGOZI
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:MBAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-728-5590
Mailing Address - Street 1:2300 VALLEY VIEW LN
Mailing Address - Street 2:SUITE 619
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-1721
Mailing Address - Country:US
Mailing Address - Phone:817-728-5590
Mailing Address - Fax:817-728-5599
Practice Address - Street 1:2300 VALLEY VIEW LN
Practice Address - Street 2:SUITE 619
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-1721
Practice Address - Country:US
Practice Address - Phone:817-728-5590
Practice Address - Fax:817-728-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010465251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010465OtherSTATE LICENSE