Provider Demographics
NPI:1942736947
Name:OMNI HOME HEALTHCARE INCORPORATED
Entity Type:Organization
Organization Name:OMNI HOME HEALTHCARE INCORPORATED
Other - Org Name:OMNI PERSONAL CARE INCORPORATED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIANTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-213-6335
Mailing Address - Street 1:12201 W NORTH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2061
Mailing Address - Country:US
Mailing Address - Phone:414-204-8462
Mailing Address - Fax:262-342-2673
Practice Address - Street 1:12201 W NORTH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2061
Practice Address - Country:US
Practice Address - Phone:414-204-8462
Practice Address - Fax:262-342-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care