Provider Demographics
NPI:1750840773
Name:NATIONWIDE RESIDENTIAL SERVICES
Entity Type:Organization
Organization Name:NATIONWIDE RESIDENTIAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDIFATAH
Authorized Official - Middle Name:
Authorized Official - Last Name:OMAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-432-3462
Mailing Address - Street 1:1150 MORSE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6327
Mailing Address - Country:US
Mailing Address - Phone:614-432-3462
Mailing Address - Fax:
Practice Address - Street 1:1150 MORSE RD STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6327
Practice Address - Country:US
Practice Address - Phone:614-432-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness