Provider Demographics
NPI:1427248871
Name:OMNI VISIONS, INC
Entity type:Organization
Organization Name:OMNI VISIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WADDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-334-0249
Mailing Address - Street 1:3717 NATIONAL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-4067
Mailing Address - Country:US
Mailing Address - Phone:919-334-0249
Mailing Address - Fax:919-334-0280
Practice Address - Street 1:5501 EXECUTIVE CENTER DR
Practice Address - Street 2:SUITE 232
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8866
Practice Address - Country:US
Practice Address - Phone:704-568-7959
Practice Address - Fax:704-568-7959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-31
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNA320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities