Healthcare Provider Details

I. General information

NPI: 1164291860
Provider Name (Legal Business Name): OMNI HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 N MAIN AVE
SCRANTON PA
18508-1880
US

IV. Provider business mailing address

PO BOX 454
MONTGOMERYVILLE PA
18936-0454
US

V. Phone/Fax

Practice location:
  • Phone: 570-507-9272
  • Fax: 570-880-7933
Mailing address:
  • Phone: 215-997-2000
  • Fax: 215-997-2282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JAN M MONTGOMERY
Title or Position: CREDENTIALING
Credential:
Phone: 215-997-2000