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General NPI Number Information
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NPI Number | 1407147705
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Entity Type | Organization
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Legal Business Name | ALPHA & OMEGA ADULT FAMILY CARE
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Dates
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Enumeration Date | 04/21/2011
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 18574 SW 55TH.
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City | MIRAMAR
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State | FL
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Zip | 33029
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Country | US
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Telephone | 954-704-3940
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Fax | 954-431-0917
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Provider Business Mailing Address
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Address Line | 18574 SW 55TH.1
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City | MIRAMAR
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State | FL
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Zip | 33029
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Country | US
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Telephone | 954-704-3940
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Fax | 954-431-0917
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHRISTINA RAPHAEL
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Credential |
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Telephone | 954-704-3940
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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 | 6906166
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License Number State | FL
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