Provider Demographics
NPI:1245385616
Name:OMNISTAR HOME HEALTH CARE, L.L.C
Entity Type:Organization
Organization Name:OMNISTAR HOME HEALTH CARE, L.L.C
Other - Org Name:OMNISTAR HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RRT
Authorized Official - Phone:469-688-5278
Mailing Address - Street 1:819 NORTH OCONNOR ROAD
Mailing Address - Street 2:201
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-4510
Mailing Address - Country:US
Mailing Address - Phone:975-445-0300
Mailing Address - Fax:972-445-0301
Practice Address - Street 1:819 NORTH O'CONNOR ROAD
Practice Address - Street 2:201
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-4510
Practice Address - Country:US
Practice Address - Phone:975-445-0300
Practice Address - Fax:972-445-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010122251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010122OtherLICENSED HOME HEALTH CARE