Provider Demographics
NPI:1275343683
Name:49 ALPHA LLC
Entity type:Organization
Organization Name:49 ALPHA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:208-212-4536
Mailing Address - Street 1:1102 KENYON RD
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5648
Mailing Address - Country:US
Mailing Address - Phone:208-212-4536
Mailing Address - Fax:
Practice Address - Street 1:1102 KENYON RD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5648
Practice Address - Country:US
Practice Address - Phone:208-212-4536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children