Provider Demographics
NPI:1083257562
Name:OMNI BEHAVIORAL SERVICES
Entity Type:Organization
Organization Name:OMNI BEHAVIORAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-247-6822
Mailing Address - Street 1:209 MARTIN LUTHER KING JR. DR.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:28352
Mailing Address - Country:US
Mailing Address - Phone:910-247-6822
Mailing Address - Fax:910-247-6829
Practice Address - Street 1:209 MARTIN LUTHER KING JR. DR.
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NC
Practice Address - Zip Code:28337-2833
Practice Address - Country:US
Practice Address - Phone:910-247-6822
Practice Address - Fax:910-247-6829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty