Healthcare Provider Details

I. General information

NPI: 1376909747
Provider Name (Legal Business Name): ALPHA HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 01/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 NIAGARA RD SUITE 102
COLLEGE PARK MD
20740-1110
US

IV. Provider business mailing address

4920 NIAGARA RD SUITE 102
COLLEGE PARK MD
20740-1110
US

V. Phone/Fax

Practice location:
  • Phone: 301-637-7078
  • Fax: 301-345-9200
Mailing address:
  • Phone: 301-637-7078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR3823R
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberR3823R
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License NumberR3823R
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR3823R
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberR3823R
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR3823R
License Number StateMD

VIII. Authorized Official

Name: OLUBUNMI SALAMI
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-637-7078