Provider Demographics
NPI:1770243990
Name:ODA HOME CARE LLC
Entity Type:Organization
Organization Name:ODA HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULAIZZ
Authorized Official - Suffix:
Authorized Official - Credentials:LAB TECHNOLOGIST
Authorized Official - Phone:701-500-6189
Mailing Address - Street 1:225 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-3601
Mailing Address - Country:US
Mailing Address - Phone:701-500-6189
Mailing Address - Fax:
Practice Address - Street 1:225 S 25TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-3601
Practice Address - Country:US
Practice Address - Phone:701-500-6189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE64472890Medicaid