Provider Demographics
NPI:1811468127
Name:OMNI HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:OMNI HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:THEVAR
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:215-997-2000
Mailing Address - Fax:215-997-2282
Practice Address - Street 1:1730 E BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5657
Practice Address - Country:US
Practice Address - Phone:570-455-0322
Practice Address - Fax:570-455-0566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020016630010Medicaid