Basic Information
| Provider Information | |||||||||
| NPI: | 1790111805 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALPHA-CARE HEALTH PROFESSIONALS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62 | ||||||||
| Address2: | |||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 618240062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173984100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6919 N KNOXVILLE AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | PEORIA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 616142817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3096913032 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2013 | ||||||||
| LastUpdateDate: | 09/20/2013 | ||||||||
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| AuthorizedOfficialLastName: | LINE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2173984100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ALPHA-CARE HEALTH PROEFESSIONALS, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 1010432 | IL | Y | Agencies | Home Health |
No ID Information.