Provider Demographics
NPI:1558760777
Name:OMNI PRIVATE DUTY, LLC
Entity Type:Organization
Organization Name:OMNI PRIVATE DUTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAND
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:586-759-9525
Mailing Address - Street 1:25932 DEQUINDRE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48091-1071
Mailing Address - Country:US
Mailing Address - Phone:586-759-9525
Mailing Address - Fax:586-582-0184
Practice Address - Street 1:25932 DEQUINDRE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48091-1071
Practice Address - Country:US
Practice Address - Phone:586-759-9525
Practice Address - Fax:586-582-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care