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General NPI Number Information
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NPI Number | 1477944221
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Entity Type | Organization
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Legal Business Name | ALPHA LIFE, LLC
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 3351 CLAYSTONE ST SE SUITE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5794
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Country | US
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Telephone | 616-499-2050
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Fax | 616-499-2070
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Provider Business Mailing Address
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Address Line | 3351 CLAYSTONE ST SE SUITE 102
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-5794
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Country | US
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Telephone | 616-499-2050
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Fax | 616-499-2070
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | STACEY BARAGAR
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Credential |
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Telephone | 616-499-2050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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