Provider Demographics
NPI:1891910337
Name:OMNIA CUM DEO CORP
Entity Type:Organization
Organization Name:OMNIA CUM DEO CORP
Other - Org Name:NEW HORIZON SHARE HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRIXIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-470-1531
Mailing Address - Street 1:2100 STATE ROAD 540 W
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1768
Mailing Address - Country:US
Mailing Address - Phone:863-299-3651
Mailing Address - Fax:863-294-4327
Practice Address - Street 1:2100 STATE ROAD 540 W
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1768
Practice Address - Country:US
Practice Address - Phone:863-299-3651
Practice Address - Fax:863-294-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5495310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1406272 00Medicaid