Provider Demographics
NPI:1942367222
Name:OMNI HOUSE INC
Entity Type:Organization
Organization Name:OMNI HOUSE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CUDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, FHFMA
Authorized Official - Phone:410-768-6777
Mailing Address - Street 1:PO BOX 1270
Mailing Address - Street 2:1421 MADISON PARK DR
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-1270
Mailing Address - Country:US
Mailing Address - Phone:410-768-6777
Mailing Address - Fax:
Practice Address - Street 1:1421 MADISON PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5613
Practice Address - Country:US
Practice Address - Phone:410-768-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17445251S00000X
MD17446320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Not Answered320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness