MEDICARE: ALPHA HERITAGE CARE HOMES LLC

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	311ZA0620X	Adult Care Home Facility
2	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1184376238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA HERITAGE CARE HOMES LLC

Provider Business Mailing Address
First Line	:	22410 AUBURN CANYON LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-5641
Country	:	US
Telephone Number	:	346-529-2762
Fax Number	:

Provider Business Practice Location Address
First Line	:	22410 AUBURN CANYON LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-5641
Country	:	US
Telephone Number	:	346-529-2762
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CHIBUNDO MARCHIE
Credential	:
Telephone Number	:	346-529-2762

Provider Enumeration Date	:	01/20/2022
Last Update Date	:	01/20/2022

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Directions to “ALPHA HERITAGE CARE HOMES LLC ” Practice Location

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