1821211871 NPI number — OMEGA HOME ,INC.

Table of content: MRS. AISHA LADI WASHINGTON MS,RD,LD (NPI 1720027972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821211871 NPI number — OMEGA HOME ,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OMEGA HOME ,INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RAINBOW OF CHALLENGES ,INC.
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821211871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1540
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71802-1540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-777-4501
Provider Business Mailing Address Fax Number:
870-777-8618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 EAST AVE. D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71802-1540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-777-6277
Provider Business Practice Location Address Fax Number:
870-777-6271
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
870-777-4501

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , with the licence number:  465 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 109394213 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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