Provider Demographics
NPI:1104484856
Name:ALPHA OMEGA ADULT HOME CARE LLC
Entity type:Organization
Organization Name:ALPHA OMEGA ADULT HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAXINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-438-2340
Mailing Address - Street 1:3001 BAY SHORE LN
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3175
Mailing Address - Country:US
Mailing Address - Phone:757-438-2340
Mailing Address - Fax:757-390-3678
Practice Address - Street 1:3001 BAY SHORE LN
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3175
Practice Address - Country:US
Practice Address - Phone:757-438-2340
Practice Address - Fax:757-390-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities