# OMEHA HOUSE I LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083204507
- **Authorized official:** OMAR DELBERT GHATTAS (OWNER)
- **Authorized official phone:** (573) 795-3614

## Contact information

- **Practice address:** 500 NORTH ST, HANNIBAL, MO 63401-3333
- **Practice address phone:** (573) 221-9103
- **Practice address fax:** (573) 406-1091
- **Mailing address:** PO BOX 387, HANNIBAL, MO 63401-0387
- **Mailing address phone:** (573) 795-3614

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320600000X | Intellectual and/or Developmental Disabilities Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 01/19/2021
- **Last updated:** 01/19/2021