Provider Demographics
NPI:1215973185
Name:OMNICARE ASSOCIATES, INC.
Entity type:Organization
Organization Name:OMNICARE ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE PRIVACY&SAFETY OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MONASTIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-768-4373
Mailing Address - Street 1:3010 LYNDON B JOHNSON FWY STE 1100
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-2712
Mailing Address - Country:US
Mailing Address - Phone:517-768-4373
Mailing Address - Fax:903-537-8420
Practice Address - Street 1:712 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4609
Practice Address - Country:US
Practice Address - Phone:469-828-0019
Practice Address - Fax:469-828-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008761251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX024661301Medicaid
TX67-7492Medicare ID - Type Unspecified
TX024661301Medicaid