1306839972 NPI number — ALPHA INC

Table of content: (NPI 1306839972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306839972 NPI number — ALPHA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA 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:
GOLDEN ACRES MANOR
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:
1306839972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 261
Provider Second Line Business Mailing Address:
1ST EAST MAIN
Provider Business Mailing Address City Name:
CARRINGTON
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58421-0261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-652-3117
Provider Business Mailing Address Fax Number:
701-652-3118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1ST EAST MAIN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARRINGTON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58421-0261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-652-3117
Provider Business Practice Location Address Fax Number:
701-652-3118
Provider Enumeration Date:
08/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
METZGER
Authorized Official First Name:
ALLAN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
701-652-3117

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1010A , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 030008 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24570 . This is a "BLUECROSSBLUESHIELDND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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