Healthcare Provider Details

I. General information

NPI: 1306839972
Provider Name (Legal Business Name): ALPHA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1ST EAST MAIN
CARRINGTON ND
58421-0261
US

IV. Provider business mailing address

PO BOX 261 1ST EAST MAIN
CARRINGTON ND
58421-0261
US

V. Phone/Fax

Practice location:
  • Phone: 701-652-3117
  • Fax: 701-652-3118
Mailing address:
  • Phone: 701-652-3117
  • Fax: 701-652-3118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1010A
License Number StateND

VIII. Authorized Official

Name: MR. ALLAN METZGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 701-652-3117