Provider Demographics
NPI:1275604993
Name:A-OMEGA INC
Entity Type:Organization
Organization Name:A-OMEGA INC
Other - Org Name:ALPHA-OMEGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR CLINICAL SERVICE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARI
Authorized Official - Middle Name:E
Authorized Official - Last Name:RIES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-737-2674
Mailing Address - Street 1:4203 WOODCOCK DR
Mailing Address - Street 2:STE 265
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1320
Mailing Address - Country:US
Mailing Address - Phone:210-737-2674
Mailing Address - Fax:210-734-2412
Practice Address - Street 1:4203 WOODCOCK DR
Practice Address - Street 2:STE 265
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1320
Practice Address - Country:US
Practice Address - Phone:210-737-2674
Practice Address - Fax:210-734-2412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX144598301Medicaid