Provider Demographics
NPI:1093511321
Name:OMNIGENESIS HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:OMNIGENESIS HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OMOWUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHORUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-418-0022
Mailing Address - Street 1:92 SHAWMONT LN
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1023
Mailing Address - Country:US
Mailing Address - Phone:609-418-0022
Mailing Address - Fax:
Practice Address - Street 1:92 SHAWMONT LN
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-1023
Practice Address - Country:US
Practice Address - Phone:609-418-0022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health