Provider Demographics
NPI:1699037697
Name:ALPHA ALLIED HOME CARE, INC.
Entity type:Organization
Organization Name:ALPHA ALLIED HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-721-6453
Mailing Address - Street 1:601 HERITAGE DR # 117
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2777
Mailing Address - Country:US
Mailing Address - Phone:561-721-6453
Mailing Address - Fax:561-658-6338
Practice Address - Street 1:601 HERITAGE DR # 117
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-2777
Practice Address - Country:US
Practice Address - Phone:561-721-6453
Practice Address - Fax:561-658-6338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017182100Medicaid
FL112002900Medicaid
FL691713596Medicaid