| Omega Independent Living Services, Inc. | |
|
3029 Stony Brook Dr Suite 105 Raleigh NC 27604-3790 | |
| (919) 255-3268 | |
| Not Available |
| Full Name | Omega Independent Living Services, Inc. |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 3029 Stony Brook Dr, Raleigh, North Carolina |
| Authorized Official Name and Position | Donald K. Grantham (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 9192553268 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Omega Independent Living Services, Inc. 3029 Stony Brook Dr Suite 105 Raleigh NC 27604-3790 Ph: (919) 255-3268 | Omega Independent Living Services, Inc. 3029 Stony Brook Dr Suite 105 Raleigh NC 27604-3790 Ph: (919) 255-3268 |
| NPI Number | 1194893842 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 06/23/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194893842 | NPI | - | NPPES |
| 6005361 | Medicaid | NC | |
| 6603739 | Medicaid | NC | |
| 6604281 | Medicaid | NC | |
| 8300455G | Medicaid | NC | |
| 6603869 | Medicaid | NC | |
| 6604054 | Medicaid | NC | |
| 8300455B | Medicaid | NC | |
| 6604021 | Medicaid | NC | |
| 6603391 | Medicaid | NC | |
| 6603948 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Primary |
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