Provider Demographics
NPI:1427426204
Name:ALPHA HORN CLASSES
Entity type:Organization
Organization Name:ALPHA HORN CLASSES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED DIABETES EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MACSHALLE
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:501-240-3579
Mailing Address - Street 1:PO BOX 25851
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72221-5851
Mailing Address - Country:US
Mailing Address - Phone:501-240-3579
Mailing Address - Fax:501-847-3010
Practice Address - Street 1:709 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-4062
Practice Address - Country:US
Practice Address - Phone:501-240-3579
Practice Address - Fax:501-847-3010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21420274302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization