Provider Demographics
NPI:1780103994
Name:ROSEFIDELIS OMNICARE, LLC
Entity type:Organization
Organization Name:ROSEFIDELIS OMNICARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SCHOLASTICA
Authorized Official - Middle Name:
Authorized Official - Last Name:NWABUEZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-413-0181
Mailing Address - Street 1:3815 ALTA VISTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721
Mailing Address - Country:US
Mailing Address - Phone:240-413-0181
Mailing Address - Fax:301-577-1436
Practice Address - Street 1:3815 ALTA VISTA DRIVE
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721
Practice Address - Country:US
Practice Address - Phone:240-413-0181
Practice Address - Fax:301-577-1436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty