Provider Demographics
NPI:1407188444
Name:OMNI HUMAN SERVICES, LLC
Entity Type:Organization
Organization Name:OMNI HUMAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDELINE
Authorized Official - Middle Name:SCANTLING
Authorized Official - Last Name:MCLAIN
Authorized Official - Suffix:
Authorized Official - Credentials:BS/QP
Authorized Official - Phone:910-818-1236
Mailing Address - Street 1:109 BEAU PKWY
Mailing Address - Street 2:D
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-7767
Mailing Address - Country:US
Mailing Address - Phone:252-337-7668
Mailing Address - Fax:252-337-6304
Practice Address - Street 1:109 BEAU PKWY
Practice Address - Street 2:D
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-7767
Practice Address - Country:US
Practice Address - Phone:252-337-7668
Practice Address - Fax:252-337-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health