Healthcare Provider Details

I. General information

NPI: 1821211871
Provider Name (Legal Business Name): OMEGA HOME ,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 01/06/2020
Certification Date: 01/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 EAST AVE. D
HOPE AR
71802-1540
US

IV. Provider business mailing address

PO BOX 1540
HOPE AR
71802-1540
US

V. Phone/Fax

Practice location:
  • Phone: 870-777-6277
  • Fax: 870-777-6271
Mailing address:
  • Phone: 870-777-4501
  • Fax: 870-777-8618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number465
License Number StateAR

VIII. Authorized Official

Name: MRS. JUDY WATSON
Title or Position: CEO
Credential:
Phone: 870-777-4501