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NPI Code Detail

MEDICARE: OMEGA GROUP LLC

MEDICARE: OMEGA GROUP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2323P00000XPsychiatric Residential Treatment Facility
3320600000XIntellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number : 1174209860
Entity Type Code : Organization
Provider Name (Legal Business Name) : OMEGA GROUP LLC
Provider Business Mailing Address
First Line : 301 S MCDOWELL ST STE 125
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-0031
Country : US
Telephone Number : 443-822-4357
Fax Number :
Provider Business Practice Location Address
First Line : 301 S MCDOWELL ST STE 125
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-0031
Country : US
Telephone Number : 443-822-4357
Fax Number :
Authorized Official
Title or Position : PARTNER / FOUNDER
Name : DR. CORIE D JOHNSON
Credential :
Telephone Number : 443-822-4357
Provider Enumeration Date : 06/26/2023
Last Update Date : 06/26/2023

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Directions to “OMEGA GROUP LLC ” Practice Location

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