Provider Demographics
NPI:1811267107
Name:OMNIPOTENT CARE HOSPICE
Entity type:Organization
Organization Name:OMNIPOTENT CARE HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:DONOVAN
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:DSC
Authorized Official - Phone:312-388-1131
Mailing Address - Street 1:10542 S EGGLESTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-2426
Mailing Address - Country:US
Mailing Address - Phone:312-388-1131
Mailing Address - Fax:708-529-3823
Practice Address - Street 1:10542 S EGGLESTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-2426
Practice Address - Country:US
Practice Address - Phone:312-388-1131
Practice Address - Fax:708-529-3823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based