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General NPI Number Information
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NPI Number | 1144583196
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Entity Type | Organization
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Legal Business Name | ALPHA HOUSE ASSISTED LIVING FACILITY-TRANSITIONAL HOUSING, INC.
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Dates
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Enumeration Date | 06/24/2012
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Last Update Date | 06/24/2012
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Provider Practice Location Address
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Address Line | 2835 VALENCIA WAY S
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City | ST PETERSBURG
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State | FL
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Zip | 33705-3635
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Country | US
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Telephone | 727-288-4735
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Fax |
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Provider Business Mailing Address
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Address Line | 2835 VALENCIA WAY S
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City | ST PETERSBURG
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State | FL
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Zip | 33705-3635
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MS. RENEE M LEE
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Credential |
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Telephone | 727-288-4735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 6906544
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License Number State | FL
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