Omeha House I LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

OMEHA HOUSE I LLC

Practice address

500 North St
Hannibal, MO 63401-3333

Phone

(573) 221-9103

Fax

(573) 406-1091

NPI assigned

Jan 19, 2021

Last updated

Jan 19, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omar Delbert Ghattas

Title

Owner

Phone

(573) 795-3614

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611014400000",
    "number": "1083204507",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 387",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634010387",
            "telephone_number": "573-795-3614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 NORTH ST",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634013333",
            "telephone_number": "573-221-9103",
            "fax_number": "573-406-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEHA HOUSE I LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-19",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A",
        "authorized_official_last_name": "GHATTAS",
        "authorized_official_first_name": "OMAR",
        "authorized_official_middle_name": "DELBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-795-3614"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M267857308",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Novak Care LLC
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• Bruno Chimerem Okoro, MD
• Theodore Oliver, LCSW
• Robert William Overstreet II, ACNPC-AG
• Lyndsey Pafford, LPN
• Jennifer Pahlman
• Kevin Terrence Palka, MD
• Erica Parker, APN

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.