Provider Demographics
NPI:1679947337
Name:OMNI CARE HOSPICE
Entity Type:Organization
Organization Name:OMNI CARE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CFP
Authorized Official - Prefix:MR
Authorized Official - First Name:AUGUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARIAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-349-0706
Mailing Address - Street 1:6225 DEAN MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-3803
Mailing Address - Country:US
Mailing Address - Phone:702-509-5276
Mailing Address - Fax:702-974-1524
Practice Address - Street 1:6225 DEAN MARTIN DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3803
Practice Address - Country:US
Practice Address - Phone:702-509-5276
Practice Address - Fax:702-974-1524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-18
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7955HPC251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV291541Medicare Oscar/Certification