Provider Demographics
NPI:1255522751
Name:OMNIPOTENT HOME ALWAY FROM HOME INC
Entity type:Organization
Organization Name:OMNIPOTENT HOME ALWAY FROM HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIA
Authorized Official - Middle Name:UCHENNA
Authorized Official - Last Name:ODILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-662-0800
Mailing Address - Street 1:8427 BASSETT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77051-1142
Mailing Address - Country:US
Mailing Address - Phone:713-662-0800
Mailing Address - Fax:713-662-0801
Practice Address - Street 1:2626 S LOOP W STE 418
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2648
Practice Address - Country:US
Practice Address - Phone:713-662-0800
Practice Address - Fax:713-662-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities