Provider Demographics
NPI:1235682642
Name:OMICRON CARE, LLC
Entity type:Organization
Organization Name:OMICRON CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-462-2460
Mailing Address - Street 1:3066 ZELDA RD
Mailing Address - Street 2:PMB # 318
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2651
Mailing Address - Country:US
Mailing Address - Phone:334-310-1012
Mailing Address - Fax:
Practice Address - Street 1:3066 ZELDA RD
Practice Address - Street 2:PMB # 318
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2651
Practice Address - Country:US
Practice Address - Phone:334-310-1012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care