=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407341175
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA-OHMS HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2018
-----------------------------------------------------
Last Update Date | 06/26/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5409 THE VYNE AVE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-8736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-655-9155
-----------------------------------------------------
Fax | 404-600-5396
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5409 THE VYNE AVE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30349-8736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-655-9155
-----------------------------------------------------
Fax | 404-600-5396
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | CHINEDU UBANI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 404-655-9155
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 060-R-1623
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------