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General NPI Number Information
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NPI Number | 1982948634
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Entity Type | Organization
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Legal Business Name | ALPHA OMEGA CONSULTING INC.
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 11/19/2012
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Provider Practice Location Address
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Address Line | 805 E JOHNS AVE
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City | DECATUR
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State | IL
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Zip | 62521-2681
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Country | US
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Telephone | 217-422-4725
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Fax | 217-422-9197
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Provider Business Mailing Address
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Address Line | 805 E JOHNS AVE
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City | DECATUR
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State | IL
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Zip | 62521-2681
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Country | US
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Telephone | 217-422-4725
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Fax | 217-422-9197
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ANGELA DENISE CORNELL
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Credential |
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Telephone | 407-977-4926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 201200010S
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License Number State | IL
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