Healthcare Provider Details

I. General information

NPI: 1477944221
Provider Name (Legal Business Name): ALPHA LIFE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 CLAYSTONE ST SE SUITE 102
GRAND RAPIDS MI
49546-5794
US

IV. Provider business mailing address

3351 CLAYSTONE ST SE SUITE 102
GRAND RAPIDS MI
49546-5794
US

V. Phone/Fax

Practice location:
  • Phone: 616-499-2050
  • Fax: 616-499-2070
Mailing address:
  • Phone: 616-499-2050
  • Fax: 616-499-2070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: STACEY BARAGAR
Title or Position: VICE PRESIDENT
Credential:
Phone: 616-499-2050