MEDICARE: ALPHA HOME CARE LLC

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	:	1417606153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA HOME CARE LLC

Provider Business Mailing Address
First Line	:	4840 ROSWELL RD STE E200
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-2671
Country	:	US
Telephone Number	:	678-967-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4840 ROSWELL RD STE E200
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-2671
Country	:	US
Telephone Number	:	678-967-8600
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. BEZ AVTZON
Credential	:
Telephone Number	:	678-967-8600

Provider Enumeration Date	:	03/21/2022
Last Update Date	:	03/21/2022

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