Provider Demographics
NPI:1891529392
Name:ALPHA OMEGA DD SERVICES LLC
Entity type:Organization
Organization Name:ALPHA OMEGA DD SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:DESIREE
Authorized Official - Last Name:NORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-267-4172
Mailing Address - Street 1:911 PEBBLE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:MILLS
Mailing Address - State:WY
Mailing Address - Zip Code:82604-8913
Mailing Address - Country:US
Mailing Address - Phone:307-267-4172
Mailing Address - Fax:
Practice Address - Street 1:1180 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-2875
Practice Address - Country:US
Practice Address - Phone:307-267-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services