Healthcare Provider Details

I. General information

NPI: 1699041723
Provider Name (Legal Business Name): OMEGA WELLNESS INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 E SOUTH TEMPLE STE 100
SALT LAKE CITY UT
84102-1689
US

IV. Provider business mailing address

770 E SOUTH TEMPLE STE 100
SALT LAKE CITY UT
84102-1689
US

V. Phone/Fax

Practice location:
  • Phone: 801-359-0903
  • Fax:
Mailing address:
  • Phone: 801-359-0903
  • 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 Code291U00000X
TaxonomyClinical Medical Laboratory
License Number46D2033732
License Number StateUT

VIII. Authorized Official

Name: LEAH STEELE BARNETT
Title or Position: MANAGING PARTNER
Credential:
Phone: 801-244-3701