Healthcare Provider Details

I. General information

NPI: 1932277076
Provider Name (Legal Business Name): OMNI FAMILY OF SERVICES NORTH CAROLINA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 BROOKDALE DR
STATESVILLE NC
28677-4107
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 704-549-1014
  • Fax: 704-924-6949
Mailing address:
  • Phone: 615-726-3603
  • Fax: 615-726-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberSO 09985A
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberNA
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number50053
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License Number
License Number StateNC

VIII. Authorized Official

Name: BRELYN REED
Title or Position: SPECIAL PROJECTS COORDINATOR
Credential:
Phone: 800-851-8905