Provider Demographics
NPI:1063615920
Name:OMEGA HOSPICE & PALLIATIVE CARE, LLC
Entity type:Organization
Organization Name:OMEGA HOSPICE & PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OLLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:847-425-9089
Mailing Address - Street 1:1717 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3735
Mailing Address - Country:US
Mailing Address - Phone:847-425-9089
Mailing Address - Fax:847-425-9091
Practice Address - Street 1:1717 HOWARD ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3735
Practice Address - Country:US
Practice Address - Phone:847-425-9089
Practice Address - Fax:847-425-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2002590251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based