Provider Demographics
NPI:1568479699
Name:OMEGA HOSPICE, LLC
Entity Type:Organization
Organization Name:OMEGA HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-536-3191
Mailing Address - Street 1:970 SWINNEA RDG
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-6037
Mailing Address - Country:US
Mailing Address - Phone:662-536-3191
Mailing Address - Fax:662-536-3196
Practice Address - Street 1:970 SWINNEA RDG
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-6037
Practice Address - Country:US
Practice Address - Phone:662-536-3191
Practice Address - Fax:662-536-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS108251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05257792Medicaid
MS251596Medicare ID - Type Unspecified