Provider Demographics
NPI:1023858966
Name:OMNI HOME CARE LLC
Entity type:Organization
Organization Name:OMNI HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-202-1602
Mailing Address - Street 1:607 NORTH AVENUE
Mailing Address - Street 2:DOOR 14-2J
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880
Mailing Address - Country:US
Mailing Address - Phone:774-362-1199
Mailing Address - Fax:
Practice Address - Street 1:607 NORTH AVENUE
Practice Address - Street 2:DOOR 14-2J
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-202-1602
Practice Address - Fax:781-202-1602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-29
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health