Healthcare Provider Details

I. General information

NPI: 1285465906
Provider Name (Legal Business Name): OMNIA TREATMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 MARKET ST FL 2
SADDLE BROOK NJ
07663-4830
US

IV. Provider business mailing address

88 MARKET ST FL 2
SADDLE BROOK NJ
07663-4830
US

V. Phone/Fax

Practice location:
  • Phone: 201-548-9462
  • Fax:
Mailing address:
  • Phone: 201-548-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES MIKHAIL
Title or Position: CEO
Credential:
Phone: 310-633-1990