Provider Demographics
NPI:1821306515
Name:OMNI DIVINE HEALTH SERVICES
Entity Type:Organization
Organization Name:OMNI DIVINE HEALTH SERVICES
Other - Org Name:OMNI DIVINE HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-701-7850
Mailing Address - Street 1:10039 BISSONNET ST STE 218
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-7852
Mailing Address - Country:US
Mailing Address - Phone:281-701-7850
Mailing Address - Fax:713-777-3418
Practice Address - Street 1:10039 BISSONNET ST
Practice Address - Street 2:218
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-7854
Practice Address - Country:US
Practice Address - Phone:281-701-7850
Practice Address - Fax:713-777-3418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health