Provider Demographics
NPI:1558978395
Name:OMACARE HOME SERVICES, LLC
Entity Type:Organization
Organization Name:OMACARE HOME SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHACONDA
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:SCREWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-314-7894
Mailing Address - Street 1:PO BOX 323
Mailing Address - Street 2:
Mailing Address - City:LUMPKIN
Mailing Address - State:GA
Mailing Address - Zip Code:31815-0323
Mailing Address - Country:US
Mailing Address - Phone:229-314-7894
Mailing Address - Fax:229-314-7900
Practice Address - Street 1:1779 BROAD STREET SUITE A
Practice Address - Street 2:
Practice Address - City:LUMPKIN
Practice Address - State:GA
Practice Address - Zip Code:31815-0323
Practice Address - Country:US
Practice Address - Phone:229-314-7894
Practice Address - Fax:229-314-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health