Provider Demographics
NPI:1194436410
Name:ALPHA-ONE HEALTHCARE LLC
Entity type:Organization
Organization Name:ALPHA-ONE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUFEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEDEJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-486-6007
Mailing Address - Street 1:12649 HEMING LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1118
Mailing Address - Country:US
Mailing Address - Phone:240-456-9912
Mailing Address - Fax:
Practice Address - Street 1:5020 SUNNYSIDE AVE STE 110
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2307
Practice Address - Country:US
Practice Address - Phone:240-486-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health