Healthcare Provider Details

I. General information

NPI: 1922339183
Provider Name (Legal Business Name): ALPHA OMEGA AMERICA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2010
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MARKET ST STE. 14
ELGIN IL
60123-5093
US

IV. Provider business mailing address

PO BOX 747
WEST DUNDEE IL
60118-0747
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-9455
  • Fax:
Mailing address:
  • Phone: 847-931-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. FLORENTINE FRANCES WILK
Title or Position: PRESIDENT
Credential: PSYD
Phone: 847-931-9455