Provider Demographics
NPI:1063532273
Name:RANCH HOPE OMEGA
Entity type:Organization
Organization Name:RANCH HOPE OMEGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTUS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-935-1555
Mailing Address - Street 1:PO BOX 325
Mailing Address - Street 2:
Mailing Address - City:ALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08001-0325
Mailing Address - Country:US
Mailing Address - Phone:856-935-1555
Mailing Address - Fax:856-935-5189
Practice Address - Street 1:45 SAWMILL ROAD
Practice Address - Street 2:
Practice Address - City:ALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08001-0325
Practice Address - Country:US
Practice Address - Phone:856-935-1555
Practice Address - Fax:856-935-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37400000X320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0216135OtherMEDICARE ID-TYPE UNSPECIFIED
NJ8385807Medicare ID - Type Unspecified