Healthcare Provider Details

I. General information

NPI: 1881761427
Provider Name (Legal Business Name): OMNI VISIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 MERRIMON AVE SUITE 3
ASHEVILLE NC
28804-2462
US

IV. Provider business mailing address

301 S PERIMETER PARK DR SUITE 210
NASHVILLE TN
37211-4143
US

V. Phone/Fax

Practice location:
  • Phone: 828-250-0629
  • Fax: 828-250-0914
Mailing address:
  • Phone: 615-726-3603
  • Fax: 615-726-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberSO 09985A
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number50053
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberNA
License Number StateNC

VIII. Authorized Official

Name: BRELYN WADDELL
Title or Position: AR MANAGER
Credential:
Phone: 919-334-0249