Provider Demographics
NPI:1225197239
Name:OMEGA INVESTMENTS INC
Entity Type:Organization
Organization Name:OMEGA INVESTMENTS INC
Other - Org Name:HERITAGE PLACE ADULT LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:NIKOUYEH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:336-209-4000
Mailing Address - Street 1:284 N EMILY CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265
Mailing Address - Country:US
Mailing Address - Phone:336-869-7907
Mailing Address - Fax:336-869-4090
Practice Address - Street 1:1372 EUFOLA RD
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677
Practice Address - Country:US
Practice Address - Phone:704-528-4568
Practice Address - Fax:704-528-9844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHAL-049-003310400000X
NCHAL049003NC310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC780216Medicaid
NC7802156Medicaid