Provider Demographics
NPI:1508054073
Name:OMEGA HEALTHCARE SYSTEMS LLC
Entity Type:Organization
Organization Name:OMEGA HEALTHCARE SYSTEMS LLC
Other - Org Name:OMEGA HOME HEALTHCARE SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:OLANMA
Authorized Official - Last Name:ISIORHO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, MSED
Authorized Official - Phone:260-497-9908
Mailing Address - Street 1:2419 LOGANBERRY CV
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9596
Mailing Address - Country:US
Mailing Address - Phone:260-497-9908
Mailing Address - Fax:
Practice Address - Street 1:519 OXFORD ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46806-4177
Practice Address - Country:US
Practice Address - Phone:260-497-9908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28142963A251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health