Provider Demographics
NPI:1396772687
Name:OMEGA HEALTHCARE SERVICES AND SUPPLY INC
Entity type:Organization
Organization Name:OMEGA HEALTHCARE SERVICES AND SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-344-8400
Mailing Address - Street 1:1127 S MANNHEIM RD
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154-2570
Mailing Address - Country:US
Mailing Address - Phone:708-344-8400
Mailing Address - Fax:708-344-8401
Practice Address - Street 1:1127 S MANNHEIM RD
Practice Address - Street 2:SUITE 216
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154-2570
Practice Address - Country:US
Practice Address - Phone:708-344-8400
Practice Address - Fax:708-344-8401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5681230001Medicare ID - Type UnspecifiedHOME MEDICAL EQUIPMENTS