Healthcare Provider Details

I. General information

NPI: 1548211907
Provider Name (Legal Business Name): ALPHA OMEGA HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 SKYVIEW CIR
SPRUCE PINE NC
28777-9518
US

IV. Provider business mailing address

5950 SIX FORKS RD
RALEIGH NC
27609-3895
US

V. Phone/Fax

Practice location:
  • Phone: 828-765-0037
  • Fax: 828-765-0039
Mailing address:
  • Phone: 919-844-1008
  • Fax: 919-844-0042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC001296
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOHN K HORNE JR.
Title or Position: CEO/PRESIDENT
Credential:
Phone: 919-844-1008