1245385616 NPI number — OMNISTAR HOME HEALTH CARE, L.L.C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245385616 NPI number — OMNISTAR HOME HEALTH CARE, L.L.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMNISTAR HOME HEALTH CARE, L.L.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245385616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
819 NORTH OCONNOR ROAD
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75061-4510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
975-445-0300
Provider Business Mailing Address Fax Number:
972-445-0301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
819 NORTH O'CONNOR ROAD
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75061-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
975-445-0300
Provider Business Practice Location Address Fax Number:
972-445-0301
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEX
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
K
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
469-688-5278

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  010122 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010122 . This is a "LICENSED HOME HEALTH CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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