Provider Demographics
NPI:1437310406
Name:OMEGA CENTRE INC
Entity type:Organization
Organization Name:OMEGA CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOHS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-489-4705
Mailing Address - Street 1:8695 COLLEGE PKWY # 2258
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4890
Mailing Address - Country:US
Mailing Address - Phone:239-489-4705
Mailing Address - Fax:239-489-2732
Practice Address - Street 1:8695 COLLEGE PKWY # 2258
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4890
Practice Address - Country:US
Practice Address - Phone:239-489-4705
Practice Address - Fax:239-489-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-22
Last Update Date:2008-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty