MEDICARE: OMNI VISIONS, 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	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		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	:	1912345349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OMNI VISIONS, INC.

Provider Business Mailing Address
First Line	:	301 S PERIMETER PARK DR
Second Line	:	STE 210
City	:	NASHVILLE
State	:	TN
Zip	:	37211-4143
Country	:	US
Telephone Number	:	615-726-3603
Fax Number	:	615-726-3632

Provider Business Practice Location Address
First Line	:	179 BYNUM PL
Second Line	:
City	:	NORLINA
State	:	NC
Zip	:	27563-9139
Country	:	US
Telephone Number	:	919-334-0249
Fax Number	:

Authorized Official
Title or Position	:	CONTRACTS MANAGER
Name	:	BRELYN WADDELL
Credential	:
Telephone Number	:	919-334-0249

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	06/13/2013

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Directions to “OMNI VISIONS, INC. ” Practice Location

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