Healthcare Provider Details

I. General information

NPI: 1326828062
Provider Name (Legal Business Name): ALPHA HOMECARE RESIDENTIAL SERVICES AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 GLENRIVER WAY
WOODBRIDGE VA
22191-5178
US

IV. Provider business mailing address

2607 GLENRIVER WAY
WOODBRIDGE VA
22191-5178
US

V. Phone/Fax

Practice location:
  • Phone: 703-945-2303
  • Fax: 571-552-3147
Mailing address:
  • Phone: 703-945-2303
  • Fax: 571-552-3147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: JOSEPHINE ALPHA
Title or Position: CEO/ADMIN
Credential: NURSE
Phone: 571-774-2345