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General NPI Number Information
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NPI Number | 1194804542
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Entity Type | Organization
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Legal Business Name | ALPHA HEALTHCARE AND NURSING SRVC LLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 407 BRIARWOOD DR
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City | JACKSON
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State | MS
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Zip | 39206-3040
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Country | US
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Telephone | 601-977-1198
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Fax | 601-977-1193
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Provider Business Mailing Address
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Address Line | PO BOX 59446
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City | JACKSON
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State | MS
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Zip | 39284-9446
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Country | US
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Telephone | 601-977-1198
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Fax | 601-977-1193
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. TOYA L GADDIS-BROWN
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Credential | R.N.
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Telephone | 601-977-1198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | PENDING
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License Number State | MS
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