# OMNI HEALTHCARE SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1477107365
- **Authorized official:** KEN IBETO (MEMBER)
- **Authorized official phone:** (678) 637-6249

## Contact information

- **Practice address:** 560 THORNTON RD STE 214, LITHIA SPRINGS, GA 30122-1656
- **Practice address phone:** (678) 637-6249
- **Practice address fax:** (404) 393-4950
- **Mailing address:** 7646 FOREST GLEN WAY, LITHIA SPRINGS, GA 30122-6867
- **Mailing address phone:** (678) 637-6249
- **Mailing address fax:** (404) 393-4950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 07/29/2019
- **Last updated:** 03/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 003207509A | — | GA |
| 01 | — | 1053807347 | NPPES | GA |