MEDICARE: OMEGA INDEPENDENT LIVING SERVICES, INC.

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
1	320800000X	Mental Illness Community Based Residential Treatment Facility	MHL-035-047	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578705570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMEGA INDEPENDENT LIVING SERVICES, INC.

Provider Business Mailing Address
First Line	:	3029 STONY BROOK DR STE 105
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27604-3790
Country	:	US
Telephone Number	:	919-255-3268
Fax Number	:

Provider Business Practice Location Address
First Line	:	127 NASH ST
Second Line	:
City	:	BUNN
State	:	NC
Zip	:	27508-7280
Country	:	US
Telephone Number	:	919-255-3268
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	MR. DONALD K GRANTHAM
Credential	:
Telephone Number	:	919-255-3268

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

Similar Medicare Providers

1588645006 — DR. CLETUS H. SIMPSON DDS
Practice Location Address:

565 MAIN STREET
BUNN, NC
27508

Practice Phone: 919-729-1103
Practice Fax: 919-729-1105

1477599850 — CORNER DRUG STORES INC
Practice Location Address:

23 EAST HIGHWAY 98 , SUITE 100
BUNN, NC
27508

Practice Phone: 919-497-1700
Practice Fax: 919-497-1777

1528099116 — MRS. LINDA S HALE NP
Practice Location Address:

101 MAIN ST
BUNN, NC
27508-9700

Practice Phone: 919-496-6511
Practice Fax: 919-496-2889

1871524322 — DR. DHRUVA KUMAR MD
Practice Location Address:

285 MAIN STREET
BUNN, NC
27508-0368

Practice Phone: 919-496-6511
Practice Fax: 919-496-2889

1366528358 — BUNN MEDICAL CENTER PA
Practice Location Address:

285 MAIN STREET
BUNN, NC
27508-0368

Practice Phone: 919-496-6511
Practice Fax: 919-496-2889

1588827257 — PAMELA ROUSE DDS
Practice Location Address:

5918 NC 39 HWY SOUTH
BUNN, NC
27508

Practice Phone: 919-496-8070
Practice Fax:

Directions to “OMEGA INDEPENDENT LIVING SERVICES, INC. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.