1417003203 NPI number — ALPHA OMEGA HEALTH INC

Table of content: (NPI 1417003203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417003203 NPI number — ALPHA OMEGA HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA OMEGA HEALTH 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:
Provider Other Organization Name Type Code:
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:
1417003203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5950 SIX FORKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27609-3895
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-844-1008
Provider Business Mailing Address Fax Number:
919-844-0042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
511 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
BURNSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28714-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-678-9544
Provider Business Practice Location Address Fax Number:
828-682-4889
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORNE
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO PRESIDENT
Authorized Official Telephone Number:
919-844-1008

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 61006394 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2335034A . This is a "MEDICARE GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8301296B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301296Q , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 286723C . This is a "MEDICARE - JOE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 6111757 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301296G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6004036 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005868 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301296A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com