Provider Demographics
NPI:1699474445
Name:OMEGA CARE SERVICES LLC
Entity type:Organization
Organization Name:OMEGA CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MODUPEOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-574-3622
Mailing Address - Street 1:1167 W BALTIMORE PIKE STE 227
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5127
Mailing Address - Country:US
Mailing Address - Phone:267-574-3622
Mailing Address - Fax:
Practice Address - Street 1:608 GARRON POINT PASS
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1994
Practice Address - Country:US
Practice Address - Phone:267-574-3622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities