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General NPI Number Information
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NPI Number | 1740541127
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Entity Type | Organization
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Legal Business Name | ALPHA-MEDICOR, LLC
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Dates
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Enumeration Date | 06/02/2012
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Last Update Date | 06/02/2012
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Provider Practice Location Address
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Address Line | 1141 CLAY AVE SUITE #3
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City | DUNMORE
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State | PA
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Zip | 18510-1191
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Country | US
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Telephone | 888-916-9937
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Fax |
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Provider Business Mailing Address
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Address Line | 1141 CLAY AVE SUITE #3
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City | DUNMORE
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State | PA
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Zip | 18510-1191
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICOLE CIPRIANI
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Credential |
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Telephone | 570-916-9989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | MD061655
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License Number State | PA
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