Provider Demographics
NPI:1669722096
Name:OMNI HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:OMNI HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMBROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-997-2000
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18936-0454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 W 15TH ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5314
Practice Address - Country:US
Practice Address - Phone:484-480-6284
Practice Address - Fax:484-480-8523
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNI HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-09-13
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
PA130030101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102001663-0032Medicaid
PA1020016630013Medicaid