Provider Demographics
NPI:1881255701
Name:OMEGA GROUP, LLC.
Entity type:Organization
Organization Name:OMEGA GROUP, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-777-3635
Mailing Address - Street 1:PO BOX 741207
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-1319
Mailing Address - Country:US
Mailing Address - Phone:678-777-3635
Mailing Address - Fax:678-731-1552
Practice Address - Street 1:1075 GLEN WILLOW DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5216
Practice Address - Country:US
Practice Address - Phone:678-777-3635
Practice Address - Fax:678-731-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities