Healthcare Provider Details

I. General information

NPI: 1205591914
Provider Name (Legal Business Name): OMNI HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2021
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 MARKET ST FL 2
UPPER DARBY PA
19082-2308
US

IV. Provider business mailing address

PO BOX 454
MONTGOMERYVILLE PA
18936-0454
US

V. Phone/Fax

Practice location:
  • Phone: 215-997-2000
  • Fax:
Mailing address:
  • Phone: 215-997-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

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