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General NPI Number Information
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NPI Number | 1245656131
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Entity Type | Organization
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Legal Business Name | OMNI FIRST HOMES, INC.
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Dates
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Enumeration Date | 03/15/2014
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Last Update Date | 03/15/2014
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Provider Practice Location Address
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Address Line | 4492 BAKERS FERRY RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-4502
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Country | US
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Telephone | 678-650-8008
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Fax |
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Provider Business Mailing Address
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Address Line | 4492 BAKERS FERRY RD SW
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City | ATLANTA
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State | GA
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Zip | 30331-4502
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Country | US
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Telephone | 678-650-8008
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CHRISTOPHER DIARRA JACKSON
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Credential |
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Telephone | 678-650-8008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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