Healthcare Provider Details

I. General information

NPI: 1023464401
Provider Name (Legal Business Name): ALFA DEVELOPMENT INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 OAK RIDGE RD.
NEWFOUNDLAND NJ
07435-1403
US

IV. Provider business mailing address

39 OAK RIDGE RD.
NEWFOUNDLAND NJ
07435-1403
US

V. Phone/Fax

Practice location:
  • Phone: 697-697-1010
  • Fax:
Mailing address:
  • Phone: 973-697-1010
  • Fax: 973-208-3699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number251C000000X
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LISA MARIE RUNNE
Title or Position: MEDICAL BILLER
Credential:
Phone: 697-697-1010