Provider Demographics
NPI:1629768049
Name:DANIELS, OMAR (PRESIDENT)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:
Last Name:DANIELS
Suffix:
Gender:M
Credentials:PRESIDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:584 VERDAE DR
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-5384
Mailing Address - Country:US
Mailing Address - Phone:864-266-3176
Mailing Address - Fax:
Practice Address - Street 1:324 N PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1631
Practice Address - Country:US
Practice Address - Phone:864-580-7010
Practice Address - Fax:864-499-3750
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility