Provider Demographics
NPI:1588361588
Name:ALPHA II OMEGA
Entity type:Organization
Organization Name:ALPHA II OMEGA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRATHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:347-400-1812
Mailing Address - Street 1:259-28 147TH RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422
Mailing Address - Country:US
Mailing Address - Phone:347-400-1812
Mailing Address - Fax:
Practice Address - Street 1:259-28 147TH RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422
Practice Address - Country:US
Practice Address - Phone:347-400-1812
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-09
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty