Provider Demographics
NPI:1780016048
Name:OMEGA GROUP OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:OMEGA GROUP OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHYTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-588-0975
Mailing Address - Street 1:2770 NW 58TH TER
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2380
Mailing Address - Country:US
Mailing Address - Phone:954-484-3712
Mailing Address - Fax:954-484-2229
Practice Address - Street 1:2770 NW 58TH TER
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-2380
Practice Address - Country:US
Practice Address - Phone:954-484-3712
Practice Address - Fax:954-484-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003955900Medicaid