Organization
OMEGA INDEPENDENT LIVING SERVICES, INC.
Active
Organization
OMEGA INDEPENDENT LIVING SERVICES, INC.
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
408 LATIMER RD, RALEIGH, NC 27609-5906
(919) 255-3268
Mailing address
3029 STONY BROOK DR STE 105, RALEIGH, NC 27604-3790
(919) 255-3268
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
MHL-092-589
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6603869
—
NC
Enumeration date
04/06/2009
Last updated
04/06/2009
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