Provider Demographics
NPI:1477980399
Name:ADMIRA HEALTHCARE SERVICES,LLC
Entity Type:Organization
Organization Name:ADMIRA HEALTHCARE SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMENKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-248-6394
Mailing Address - Street 1:4613 CUTLASS DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-2515
Mailing Address - Country:US
Mailing Address - Phone:937-248-6394
Mailing Address - Fax:
Practice Address - Street 1:4613 CUTLASS DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-2515
Practice Address - Country:US
Practice Address - Phone:937-248-6394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care