NPIMap

Organization Active NPI

Omniacare LLC

  • Community Based Hospice Care Agency
  • Mesquite, NV
National Provider Identifier
1902402894
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
OMNIACARE LLC
Practice address
350 Falcon Ridge Pkwy Ste 101
Mesquite, NV 89027-8879
Phone
(702) 849-0585
Fax
(702) 849-0614
NPI assigned
Dec 7, 2020
Last updated
Oct 4, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Vanessa Dawn Barben, RN
Title
Part Owner
Phone
(435) 467-8201

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

350 Falcon Ridge Pkwy Ste 101
Mesquite, NV 89027-8879

Mailing address

1977 E 2590 South Cir
St George, UT 84790-7024
Phone (435) 467-8201

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vanessa@dixiecare.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210813000053 NV Part A Provider - Hospice 8527462522 Practice locations: Mesquite, NV

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902402894. Details of each certification follow.

Hospice certification: CCN 291617

Legal name
OMNIACARE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 21, 2022
Last certification
Jan 21, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Incorporated
Nov 23, 2020 in NV
Enrollment address
350 Falcon Ridge Pkwy
Ste 101
Mesquite, NV 89027-8879

Care Compare: Hospice

Medicare Care Compare
Listed as
Omniacare LLCCCN 291617 · All quality measures
Ownership
For-Profit
Certified
Jan 21, 2022
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William S Hokanson Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2021 50%
Jamie Brannum Individual W-2 Managing EmployeeClinical Manager Dec 18, 2023
Vance Marshal Washington Individual Corporate DirectorMedical Director Jul 12, 2024 100%
Jennifer Williams Individual W-2 Managing EmployeeHuman Resources Jun 29, 2021 100%
Angie McLemore Individual W-2 Managing EmployeeAdministraor Jan 1, 2024 100%
Vanessa Barben Individual 5% Or Greater Direct Ownership InterestOwner Jan 1, 2021 50%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 5

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633305600000",
    "number": "1902402894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1977 E 2590 SOUTH CIR",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847907024",
            "telephone_number": "435-467-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 FALCON RIDGE PKWY STE 101",
            "city": "MESQUITE",
            "state": "NV",
            "postal_code": "890278879",
            "telephone_number": "702-849-0585",
            "fax_number": "702-849-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMNIACARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A",
        "authorized_official_last_name": "BARBEN",
        "authorized_official_first_name": "VANESSA",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "PART OWNER",
        "authorized_official_telephone_number": "435-467-8201",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vanessa@dixiecare.com",
            "affiliation": "N",
            "endpointDescription": "personal email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "hospice",
            "address_1": "350 Falcon Ridge Pkwy Ste 101",
            "city": "Mesquite",
            "state": "NV",
            "country_code": "US",
            "postal_code": "890278879",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mesquite, NV

Sources for this page

Verify at the official NPI Registry.