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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
2410 PINEY PLAINS RD, CARY, NC 27518-6868
(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-092-702
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
6604281
NC
Enumeration date
04/06/2009
Last updated
04/06/2009
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