Provider Demographics
NPI:1942516943
Name:OMNILIFE SYSTEMS INC
Entity Type:Organization
Organization Name:OMNILIFE SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:BANASIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-299-3100
Mailing Address - Street 1:PO BOX 8309
Mailing Address - Street 2:50 W FIFTH AVE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-0309
Mailing Address - Country:US
Mailing Address - Phone:614-299-3100
Mailing Address - Fax:614-299-3813
Practice Address - Street 1:50 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-3219
Practice Address - Country:US
Practice Address - Phone:614-299-3100
Practice Address - Fax:614-299-3813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36H115OtherMEDICARE