Provider Demographics
NPI:1720525678
Name:OMNI YOUTH SERVICES
Entity Type:Organization
Organization Name:OMNI YOUTH SERVICES
Other - Org Name:OMNI YOUTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DORYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-353-1758
Mailing Address - Street 1:210 N WOLF RD
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-2922
Mailing Address - Country:US
Mailing Address - Phone:847-353-1500
Mailing Address - Fax:
Practice Address - Street 1:210 N WOLF RD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-2922
Practice Address - Country:US
Practice Address - Phone:847-353-1500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMNI YOUTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-30
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder