Basic Information
| Provider Information | |||||||||
| NPI: | 1558730267 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA OMEGA HOSPICE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3021 LORNA RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352164587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055337215 | ||||||||
| FaxNumber: | 2055882134 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 NE LOOP 820 | ||||||||
| Address2: | |||||||||
| City: | HURST | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760537209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172380770 | ||||||||
| FaxNumber: | 8172380786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2015 | ||||||||
| LastUpdateDate: | 09/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | ENGLISH | ||||||||
| AuthorizedOfficialFirstName: | NORMA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2055338475 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251G00000X | 009222 | TX | Y | Agencies | Hospice Care, Community Based |
ID Information
| ID | Type | State | Issuer | Description | 001012983 | 05 | TX | MEDICAID |