Provider Demographics
NPI:1437715539
Name:OMEGA RAY LLC
Entity Type:Organization
Organization Name:OMEGA RAY LLC
Other - Org Name:OMEGA RAY HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOSULE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-917-5290
Mailing Address - Street 1:923 PITT RD
Mailing Address - Street 2:
Mailing Address - City:CHELTENHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19012-1627
Mailing Address - Country:US
Mailing Address - Phone:215-917-5290
Mailing Address - Fax:
Practice Address - Street 1:261 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3706
Practice Address - Country:US
Practice Address - Phone:215-917-5290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-14
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care