NPIMap

Organization Active NPI

Omega Independent Living Services, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Raleigh, NC
National Provider Identifier
1194893842
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
Legal business name
OMEGA INDEPENDENT LIVING SERVICES, INC.
Practice address
3029 Stony Brook Dr
Suite 105
Raleigh, NC 27604-3790
Phone
(919) 255-3268
NPI assigned
Dec 1, 2006
Last updated
Jun 23, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Authorized official

Name
Donald K. Grantham
Title
Director of Operations
Phone
(919) 255-3268

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X
Mental Illness Community Based Residential Treatment Facility 320800000X Primary

Addresses

Primary practice location

3029 Stony Brook Dr
Suite 105
Raleigh, NC 27604-3790

Mailing address

3029 Stony Brook Dr
Suite 105
Raleigh, NC 27604-3790
Phone (919) 255-3268

Other identifiers 10

IdentifierTypeStateIssuer
6005361MedicaidNC
6603739MedicaidNC
6604281MedicaidNC
8300455GMedicaidNC
6603869MedicaidNC
6604054MedicaidNC
8300455BMedicaidNC
6604021MedicaidNC
6603391MedicaidNC
6603948MedicaidNC

National Provider Directory

National Provider Directory
Tax ID family
Omega Independent Living Services Inc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214179200000",
    "number": "1194893842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3029 STONY BROOK DR",
            "address_2": "SUITE 105",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276043790",
            "telephone_number": "919-255-3268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3029 STONY BROOK DR",
            "address_2": "SUITE 105",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276043790",
            "telephone_number": "919-255-3268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGA INDEPENDENT LIVING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2008-06-23",
        "status": "A",
        "authorized_official_last_name": "GRANTHAM",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "919-255-3268"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6005361",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603739",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604281",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300455G",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603869",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604054",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8300455B",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6604021",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603391",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603948",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2008; 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.