Provider Demographics
NPI:1962813071
Name:OMNIA HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:OMNIA HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:NICHOLES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:208-907-1790
Mailing Address - Street 1:305 N. LINCOLN STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-6412
Mailing Address - Country:US
Mailing Address - Phone:208-907-1790
Mailing Address - Fax:
Practice Address - Street 1:305 N. LINCOLN STREET
Practice Address - Street 2:SUITE B
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-6412
Practice Address - Country:US
Practice Address - Phone:208-907-1790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-12
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID137125Medicare Oscar/Certification