NPIMap

Organization Active NPI

Omega Independent Living Services, Inc.

  • Mental Illness Community Based Residential Treatment Facility
  • Linden, NC
National Provider Identifier
1255573259
Registry record updated Apr 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
MHL-026-739 Issued in NC
Legal business name
OMEGA INDEPENDENT LIVING SERVICES, INC.
Practice address
8619 Tangletree Dr
Linden, NC 28356-9528
Phone
(919) 255-3268
NPI assigned
Apr 6, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2009

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X MHL-026-739 NC Primary

Addresses

Primary practice location

8619 Tangletree Dr
Linden, NC 28356-9528

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
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": "1238976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238976000000",
    "number": "1255573259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3029 STONY BROOK DR STE 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": "8619 TANGLETREE DR",
            "city": "LINDEN",
            "state": "NC",
            "postal_code": "283569528",
            "telephone_number": "919-255-3268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMEGA INDEPENDENT LIVING SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-06",
        "last_updated": "2009-04-06",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NC",
            "license": "MHL-026-739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6603948",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Linden, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2009; 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.