Provider Demographics
NPI:1396780946
Name:OMADA, INC.
Entity type:Organization
Organization Name:OMADA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:507-664-9407
Mailing Address - Street 1:401 DIVISION ST S
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55057-2095
Mailing Address - Country:US
Mailing Address - Phone:507-664-9407
Mailing Address - Fax:507-664-3862
Practice Address - Street 1:401 DIVISION ST S
Practice Address - Street 2:SUITE A
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2095
Practice Address - Country:US
Practice Address - Phone:507-664-9407
Practice Address - Fax:507-664-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1023523-2-CDT261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
173158OtherUCARE
5045989OtherMEDICA/UBH
91167OtherHEALTHPARTNERS
2H51OMOtherBCBS
124611OtherMMSI
1032951OtherPREFERRED ONE