MEDICARE: 49 ALPHA 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1275343683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	49 ALPHA LLC

Provider Business Mailing Address
First Line	:	1102 KENYON RD
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5648
Country	:	US
Telephone Number	:	208-308-0158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1102 KENYON RD
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-5648
Country	:	US
Telephone Number	:	208-212-4536
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. GLEN THORNE JR.
Credential	:
Telephone Number	:	208-212-4536

Provider Enumeration Date	:	01/08/2025
Last Update Date	:	09/09/2025

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