1801088489 NPI number — ALPHA HOME HEALTH CARE LLC

Table of content: (NPI 1801088489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801088489 NPI number — ALPHA HOME HEALTH CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA HOME HEALTH CARE LLC
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:
CHOICE HEALTH AT HOME WESTERN OKLAHOMA HOME HEALTH
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:
1801088489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6760 OLD JACKSON HWY
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75703-9055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-363-9932
Provider Business Mailing Address Fax Number:
888-333-8977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7512 BROADWAY EXT
Provider Second Line Business Practice Location Address:
STE 312
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73116-9055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-463-5695
Provider Business Practice Location Address Fax Number:
405-463-5697
Provider Enumeration Date:
08/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LANIER
Authorized Official First Name:
KATRINA
Authorized Official Middle Name:
DAWN
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
903-932-1852

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7865 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7865 . This is a "LICENSE" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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