Provider Demographics
NPI:1609028547
Name:OMEGA HEALTH CARE OF NORTHWEST MISSOURI, INC.
Entity Type:Organization
Organization Name:OMEGA HEALTH CARE OF NORTHWEST MISSOURI, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSS
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-814-7105
Mailing Address - Street 1:3171 NE CARNEGIE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-3215
Mailing Address - Country:US
Mailing Address - Phone:816-268-4130
Mailing Address - Fax:
Practice Address - Street 1:3171 NE CARNEGIE DR
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-3215
Practice Address - Country:US
Practice Address - Phone:816-268-4130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00919007251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based