Omeha House I LLC

NPI #1083204507 in Hannibal, Missouri

Provider Information

NPI Number: 1083204507
Entity Type: Organization
Organization Name: Omeha House I LLC
Primary Specialty: Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jan 19, 2021
Last Updated: Jan 19, 2021

Practice Location

Address: 500 NORTH ST
City: Hannibal
State: Missouri
ZIP Code: 63401-3333
Phone: (573) 221-9103

Authorized Official

Name: OMAR DELBERT GHATTAS
Title: OWNER
Phone: (573) 795-3614

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320600000X	Primary

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