Organization
OMEGA INDEPENDENT LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD K. GRANTHAM (DIRECTOR OF OPERATIONS)
(919) 255-3268
Entity
Organization
Contact information
Practice address
3029 STONY BROOK DR STE 105, RALEIGH, NC 27604-3790
(919) 255-3268
(919) 250-2004
Mailing address
3029 STONY BROOK DR STE 105, RALEIGH, NC 27604-3790
(919) 255-3268
(919) 250-2004
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8300455H
—
NC
Enumeration date
02/23/2010
Last updated
02/24/2010
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