Organization
OMNI HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KEDRA DANIEL (OWNER)
(678) 353-1985
Entity
Organization
Contact information
Practice address
255 BROOKCLEAR LN, FAYETTEVILLE, GA 30215-4639
(678) 353-1985
Mailing address
255 BROOKCLEAR LN, FAYETTEVILLE, GA 30215-4639
(678) 353-1985
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
314000000X
Skilled Nursing Facility
—
—
3140N1450X
Pediatric Skilled Nursing Facility
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
385HR2065X
Child Physical Disabilities Respite Care
—
—
Other
Enumeration date
04/11/2023
Last updated
05/05/2023
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