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General NPI Number Information
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NPI Number | 1821356858
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Entity Type | Organization
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Legal Business Name | OMEGA GROUP AT SOUTH PL. INC.
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 04/27/2012
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Provider Practice Location Address
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Address Line | 2770 NW 58TH TER
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City | LAUDERHILL
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State | FL
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Zip | 33313-2380
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Country | US
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Telephone | 954-588-0975
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Fax | 954-484-2229
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Provider Business Mailing Address
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Address Line | 2770 NW 58TH TER
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City | LAUDERHILL
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State | FL
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Zip | 33313-2380
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Country | US
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Telephone | 954-588-0975
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Fax | 954-484-2229
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Authorized Official
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Title or Position | OWNER
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Name | MS. SONIA WHYTE
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Credential | ADMINASTRATIVE
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Telephone | 954-588-0975
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | AL8974
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License Number State | FL
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