Provider Demographics
NPI:1912944810
Name:OMRO HEALTHCARE LLC
Entity Type:Organization
Organization Name:OMRO HEALTHCARE LLC
Other - Org Name:OMRO CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:920-685-2755
Mailing Address - Street 1:500 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:OMRO
Mailing Address - State:WI
Mailing Address - Zip Code:54963-1342
Mailing Address - Country:US
Mailing Address - Phone:920-685-2755
Mailing Address - Fax:920-685-0599
Practice Address - Street 1:500 GRANT AVE
Practice Address - Street 2:
Practice Address - City:OMRO
Practice Address - State:WI
Practice Address - Zip Code:54963-1342
Practice Address - Country:US
Practice Address - Phone:920-685-2755
Practice Address - Fax:920-685-0599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3241314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20192900Medicaid
525406Medicare Oscar/Certification