Provider Demographics
NPI:1427674670
Name:OMNI SENIOR CARE SOLUTIONS
Entity type:Organization
Organization Name:OMNI SENIOR CARE SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMENKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-536-1467
Mailing Address - Street 1:3540 E BROAD ST # 141
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5633
Mailing Address - Country:US
Mailing Address - Phone:904-536-1467
Mailing Address - Fax:
Practice Address - Street 1:4412 ASHBURY LN
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6702
Practice Address - Country:US
Practice Address - Phone:904-536-1467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care