Healthcare Provider Details

I. General information

NPI: 1578089298
Provider Name (Legal Business Name): ALFA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 03/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 LAKESIDE AVE
CHERRY HILL NJ
08003-3611
US

IV. Provider business mailing address

10 LAKESIDE AVE
CHERRY HILL NJ
08003-3611
US

V. Phone/Fax

Practice location:
  • Phone: 856-428-1100
  • Fax:
Mailing address:
  • Phone: 856-428-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNJ

VIII. Authorized Official

Name: MR. ASHIER RESPES
Title or Position: OWNER
Credential:
Phone: 856-428-1100