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Organization

OMEGA INDEPENDENT LIVING SERVICES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DONALD K. GRANTHAM (DIRECTOR OF OPERATIONS)
(919) 255-3268
Entity
Organization

Contact information

Practice address
3029 STONY BROOK DR, SUITE 105, RALEIGH, NC 27604-3790
(919) 255-3268
Mailing address
3029 STONY BROOK DR, SUITE 105, RALEIGH, NC 27604-3790
(919) 255-3268

Taxonomy

Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6005361
NC
05
6603391
NC
05
6603739
NC
05
6603869
NC
05
6603948
NC
05
6604021
NC
05
6604054
NC
05
6604281
NC
05
8300455B
NC
05
8300455G
NC
Enumeration date
12/01/2006
Last updated
06/23/2008
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