MEDICARE: ALPHA & OMEGA COMMUNITY SERVICES CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251V00000X	Voluntary or Charitable Agency		DC

General Provider Information

NPI Number	:	1033624176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA & OMEGA COMMUNITY SERVICES CORPORATION

Provider Business Mailing Address
First Line	:	1643 W VIRGINIA AVE NE APT 2
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-2360
Country	:	US
Telephone Number	:	240-421-4105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1643 W VIRGINIA AVE NE APT 2
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20002-2360
Country	:	US
Telephone Number	:	240-421-4105
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/FOUNDER
Name	:	KIM RENEE BLOWE
Credential	:	LPN
Telephone Number	:	240-421-4105

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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