Organization
OMNI HEALTHCARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN IBETO (MEMBER)
(678) 637-6249
Entity
Organization
Contact information
Practice address
560 THORNTON RD STE 214, LITHIA SPRINGS, GA 30122-1656
(678) 637-6249
(404) 393-4950
Mailing address
7646 FOREST GLEN WAY, LITHIA SPRINGS, GA 30122-6867
(678) 637-6249
(404) 393-4950
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003207509A
—
GA
01
—
1053807347
NPPES
GA
Enumeration date
07/29/2019
Last updated
03/27/2023
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