Provider Demographics
NPI:1912266347
Name:OMEGA ALPHA NU MINISTRIES
Entity Type:Organization
Organization Name:OMEGA ALPHA NU MINISTRIES
Other - Org Name:OAN MENTAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONSALVES-BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:321-236-2006
Mailing Address - Street 1:PO BOX 451236
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-1236
Mailing Address - Country:US
Mailing Address - Phone:321-236-2006
Mailing Address - Fax:321-250-7822
Practice Address - Street 1:101 W CYPRESS ST
Practice Address - Street 2:SUITE E, F & K
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-3319
Practice Address - Country:US
Practice Address - Phone:321-236-2006
Practice Address - Fax:321-250-7822
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMEGA ALPHA NU MINISTRIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-05-04
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004861300Medicaid