=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164291936
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OMNI FAMILY OF SERVICES OHIO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2023
-----------------------------------------------------
Last Update Date | 12/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5720 SIGNAL HILL CT STE A
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45150-1481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-682-0715
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 301 S PERIMETER PARK DR
-----------------------------------------------------
City | NASHVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37211-4143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-834-1885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JANE WINTZ
-----------------------------------------------------
Credential | LISW
-----------------------------------------------------
Telephone | 615-834-1885
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------