Basic Information
| Provider Information | |||||||||
| NPI: | 1023154218 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA OMEGA HEALTH INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5950 SIX FORKS RD | ||||||||
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| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276093895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198441008 | ||||||||
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| Practice Location | |||||||||
| Address1: | 72 BLUE RIDGE LN | ||||||||
| Address2: | |||||||||
| City: | BURNSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287147270 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286822111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2007 | ||||||||
| LastUpdateDate: | 03/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | HORNE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9198441008 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 8301777G | 05 | NC | MEDICAID | 6004036 | 05 | NC | MEDICAID | 6106394 | 05 | NC | MEDICAID | 8301777B | 05 | NC | MEDICAID | 8301777A | 05 | NC | MEDICAID | 6005947 | 05 | NC | MEDICAID |