Provider Demographics
NPI:1972265288
Name:ALPHA OMEGA BEHAVIORAL CARE, LLC
Entity type:Organization
Organization Name:ALPHA OMEGA BEHAVIORAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YONAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRHA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:602-410-8468
Mailing Address - Street 1:7027 S 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2266
Mailing Address - Country:US
Mailing Address - Phone:602-410-8468
Mailing Address - Fax:
Practice Address - Street 1:6638 S 26TH LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5369
Practice Address - Country:US
Practice Address - Phone:602-410-8468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health