Provider Demographics
NPI:1659039410
Name:OMEGA MOBILE WELLNESS LLC
Entity Type:Organization
Organization Name:OMEGA MOBILE WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-499-8406
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:PANOLA
Mailing Address - State:AL
Mailing Address - Zip Code:35477-0054
Mailing Address - Country:US
Mailing Address - Phone:205-499-8406
Mailing Address - Fax:
Practice Address - Street 1:578 PINE CREST VLG
Practice Address - Street 2:
Practice Address - City:ALICEVILLE
Practice Address - State:AL
Practice Address - Zip Code:35442-7044
Practice Address - Country:US
Practice Address - Phone:205-499-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty