Basic Information
| Provider Information | |||||||||
| NPI: | 1235361544 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OMEGA HEALTH CARE OF NORTHEAST GEORGIA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7520 W 160TH ST | ||||||||
| Address2: | |||||||||
| City: | STILWELL | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660858100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703825055 | ||||||||
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| Practice Location | |||||||||
| Address1: | 27 MAPLE RIDGE DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CARTERSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301212293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703825055 | ||||||||
| FaxNumber: | 7703827488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2009 | ||||||||
| LastUpdateDate: | 10/04/2013 | ||||||||
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| AuthorizedOfficialLastName: | ROGERS | ||||||||
| AuthorizedOfficialFirstName: | RUSS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9137085391 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | GA | Y | Agencies | Hospice Care, Community Based |
No ID Information.