Healthcare Provider Details

I. General information

NPI: 1033408018
Provider Name (Legal Business Name): ALPHA 1 HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 PINE ARBOR DR
LEESBURG GA
31763-3184
US

IV. Provider business mailing address

104 PINE ARBOR DR
LEESBURG GA
31763-3184
US

V. Phone/Fax

Practice location:
  • Phone: 229-296-8478
  • Fax: 229-299-2909
Mailing address:
  • Phone: 229-296-8478
  • Fax: 229-299-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number088R0560
License Number StateGA

VIII. Authorized Official

Name: MRS. SCHVON YVETTE BUSEY
Title or Position: ADMINISTRATOR/RN
Credential: RN
Phone: 229-296-8478