Healthcare Provider Details

I. General information

NPI: 1134944234
Provider Name (Legal Business Name): ALPHA HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5864 QUILLEY AVE NE
OTSEGO MN
55330-6689
US

IV. Provider business mailing address

5864 QUILLEY AVE NE
OTSEGO MN
55330-6689
US

V. Phone/Fax

Practice location:
  • Phone: 612-532-0019
  • Fax:
Mailing address:
  • Phone: 612-532-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State

VIII. Authorized Official

Name: LABAN N ATEMBA
Title or Position: MANAGER
Credential: MR
Phone: 612-532-0019