Provider Demographics
NPI:1427560572
Name:1ST OMEGA HCS COMPANY
Entity type:Organization
Organization Name:1ST OMEGA HCS COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DETRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-975-3776
Mailing Address - Street 1:PO BOX 894
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:75686-0894
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3946 FM 1647
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:TX
Practice Address - Zip Code:75494-8776
Practice Address - Country:US
Practice Address - Phone:903-975-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid