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General NPI Number Information
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NPI Number | 1275343683
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Entity Type | Organization
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Legal Business Name | 49 ALPHA LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 1102 KENYON RD
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City | TWIN FALLS
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State | ID
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Zip | 83301-5648
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Country | US
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Telephone | 208-212-4536
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 KENYON RD
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City | TWIN FALLS
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State | ID
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Zip | 83301-5648
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Country | US
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Telephone | 208-308-0158
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. GLEN THORNE JR.
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Credential |
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Telephone | 208-212-4536
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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