MEDICARE: ALPHA & OMEGA RESIDENTIAL INC.

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	310400000X	Assisted Living Facility	AL9526	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093906091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA & OMEGA RESIDENTIAL INC.

Provider Business Mailing Address
First Line	:	410 E 24TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3922
Country	:	US
Telephone Number	:	305-691-6335
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 E 24TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-3922
Country	:	US
Telephone Number	:	305-691-6335
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. BARBARA CALVINO
Credential	:
Telephone Number	:	786-306-6433

Provider Enumeration Date	:	08/05/2007
Last Update Date	:	05/16/2017

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