MEDICARE: ALPHA PHI ALPHA HOMES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1093131435
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA PHI ALPHA HOMES, INC

Provider Business Mailing Address
First Line	:	662 WOLF LEDGES PKWY
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1511
Country	:	US
Telephone Number	:	330-376-8787
Fax Number	:	330-376-6437

Provider Business Practice Location Address
First Line	:	662 WOLF LEDGES PKWY
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44311-1511
Country	:	US
Telephone Number	:	330-376-8787
Fax Number	:	330-376-6437

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. THOMAS RYAN FULLER
Credential	:	MA
Telephone Number	:	330-319-2400

Provider Enumeration Date	:	03/10/2014
Last Update Date	:	03/10/2014

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