Provider Demographics
NPI:1811908213
Name:OMNI HOME HEALTH SERVICES OF EASTERN CONNECTICUT, LLC
Entity type:Organization
Organization Name:OMNI HOME HEALTH SERVICES OF EASTERN CONNECTICUT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOHR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-889-8331
Mailing Address - Street 1:12 CASE STREET
Mailing Address - Street 2:SUITE 317
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2222
Mailing Address - Country:US
Mailing Address - Phone:860-889-7198
Mailing Address - Fax:860-892-6694
Practice Address - Street 1:12 CASE STREET
Practice Address - Street 2:SUITE 317
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2222
Practice Address - Country:US
Practice Address - Phone:860-889-7198
Practice Address - Fax:860-892-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTC9714610251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004171237Medicaid
CT9366321OtherUNEMPLOYMENT PROVIDER NUM
CT004171237077214Medicaid
CT9366321OtherUNEMPLOYMENT PROVIDER NUM