Provider Demographics
NPI:1700996949
Name:OMEGA REHABILITATION GROUP
Entity Type:Organization
Organization Name:OMEGA REHABILITATION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:CATHEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:901-346-0010
Mailing Address - Street 1:PO BOX 751982
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38175-1982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3733 STEVENS LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37218-1205
Practice Address - Country:US
Practice Address - Phone:901-346-0010
Practice Address - Fax:901-346-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5958174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3713875Medicaid
TN3713875Medicare PIN