Provider Demographics
NPI:1720060601
Name:OMNI HOME HEALTH DISTRICT 4, LLC
Entity Type:Organization
Organization Name:OMNI HOME HEALTH DISTRICT 4, LLC
Other - Org Name:ST. VINCENT'S HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF LICENSING & ACCREDITATI
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-712-2250
Mailing Address - Street 1:510 HOSPITAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5033
Mailing Address - Country:US
Mailing Address - Phone:615-712-2250
Mailing Address - Fax:615-577-0081
Practice Address - Street 1:2651 PARK ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4519
Practice Address - Country:US
Practice Address - Phone:904-389-7385
Practice Address - Fax:904-389-7359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991765251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004233000Medicaid
FL108215Medicare Oscar/Certification