Healthcare Provider Details

I. General information

NPI: 1609783182
Provider Name (Legal Business Name): ALPHA VITA HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 SHERIDAN RD
KENOSHA WI
53143-5063
US

IV. Provider business mailing address

6530 SHERIDAN RD
KENOSHA WI
53143-5063
US

V. Phone/Fax

Practice location:
  • Phone: 262-657-8360
  • Fax: 262-657-8389
Mailing address:
  • Phone: 262-657-8360
  • Fax: 262-657-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RODRIGUEZ
Title or Position: OWNER
Credential: APRN
Phone: 262-705-6846