Provider Demographics
NPI:1639435712
Name:OMNI DIVINE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:OMNI DIVINE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/ALT DON
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:C U
Authorized Official - Last Name:MOSES
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSC(NUR),MED
Authorized Official - Phone:281-787-7789
Mailing Address - Street 1:17743 PLANTERS PATH LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-5182
Mailing Address - Country:US
Mailing Address - Phone:281-787-7789
Mailing Address - Fax:832-363-3649
Practice Address - Street 1:17743 PLANTERS PATH LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-5182
Practice Address - Country:US
Practice Address - Phone:281-787-7789
Practice Address - Fax:832-363-3649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
TXNOT YET LICENSED251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health