Provider Demographics
NPI:1679682553
Name:OMEGA HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:OMEGA HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:NELIA
Authorized Official - Middle Name:GUINSATAO
Authorized Official - Last Name:LAUREL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-433-0163
Mailing Address - Street 1:1717 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3735
Mailing Address - Country:US
Mailing Address - Phone:847-425-9089
Mailing Address - Fax:847-425-9091
Practice Address - Street 1:1717 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3735
Practice Address - Country:US
Practice Address - Phone:847-425-9089
Practice Address - Fax:847-425-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010195251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147735Medicare ID - Type Unspecified