Provider Demographics
NPI:1174689632
Name:OMNI HOME CARE
Entity Type:Organization
Organization Name:OMNI HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:LORENE
Authorized Official - Last Name:SELIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-519-9233
Mailing Address - Street 1:9143 PHILIPS HWY
Mailing Address - Street 2:SUITE 190
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-1348
Mailing Address - Country:US
Mailing Address - Phone:904-519-9233
Mailing Address - Fax:904-519-9244
Practice Address - Street 1:9143 PHILIPS HWY
Practice Address - Street 2:SUITE 190
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1348
Practice Address - Country:US
Practice Address - Phone:904-519-9233
Practice Address - Fax:904-519-9244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107707Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER