Provider Demographics
NPI:1922037829
Name:OMNI PARK HEALTH CARE, LLC
Entity Type:Organization
Organization Name:OMNI PARK HEALTH CARE, LLC
Other - Org Name:OMNI PARK HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MAYNARD
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:216-289-8963
Mailing Address - Street 1:27801 EUCLID AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3549
Mailing Address - Country:US
Mailing Address - Phone:216-289-8963
Mailing Address - Fax:216-289-9114
Practice Address - Street 1:27801 EUCLID AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3549
Practice Address - Country:US
Practice Address - Phone:216-289-8963
Practice Address - Fax:216-289-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2893525Medicaid
OH2893525Medicaid