| Organization Name: | OMEGA INDEPENDENT LIVING SERVICES |
| NPI Number: | 1083936686 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DONALD K. GRANTHAM (DIRECTOR OF OPERATIONS) |
| Mailing Address: | 3029 Stony Brook Dr Ste 105 Raleigh |
| State: | NC US |
| Postal Code: | 276043790 |
| Phone Number: | 9192553268 |
| Fax Number: | 9192502004 |
| NPI Enumeration Date: | 02/23/2010 |
| NPI Last Update Date: | 02/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 253Z00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | In Home Supportive Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An In Home Supportive Care Agency provides services in the patient |