MEDICARE: ALPHA GROUP ADMINISTRATORS, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	251C00000X	Developmentally Disabled Services Day Training Agency	AZ
2	253Z00000X	In Home Supportive Care Agency	AZ
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility	AZ
4	251S00000X	Community/Behavioral Health Agency	AZ

General Provider Information

NPI Number	:	1073848867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA GROUP ADMINISTRATORS, INC.

Provider Business Mailing Address
First Line	:	11070 N 24TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4705
Country	:	US
Telephone Number	:	602-375-8553
Fax Number	:	602-375-0057

Provider Business Practice Location Address
First Line	:	11070 N 24TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-4705
Country	:	US
Telephone Number	:	602-375-8553
Fax Number	:	602-375-0057

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRIDGETT LINNEBACH
Credential	:
Telephone Number	:	602-375-8553

Provider Enumeration Date	:	10/12/2009
Last Update Date	:	10/12/2009

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