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General NPI Number Information
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NPI Number | 1053589739
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Entity Type | Organization
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Legal Business Name | ALPHA & OMEGA HOME CARE
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 02/14/2008
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Provider Practice Location Address
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Address Line | 3024 TOULON RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-7664
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Country | US
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Telephone | 321-722-9442
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Fax | 321-722-9442
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Provider Business Mailing Address
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Address Line | 3024 TOULON RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-7664
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Country | US
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Telephone | 321-722-9442
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Fax | 321-722-9442
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARIE MEDELON
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Credential |
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Telephone | 321-722-9442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906143
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License Number State | FL
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