Provider Demographics
NPI:1033767181
Name:ALPHA GROUP HOMES LLC
Entity Type:Organization
Organization Name:ALPHA GROUP HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FLORA
Authorized Official - Middle Name:
Authorized Official - Last Name:IYOHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-840-4531
Mailing Address - Street 1:15419 N 23RD LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-4211
Mailing Address - Country:US
Mailing Address - Phone:602-675-0678
Mailing Address - Fax:
Practice Address - Street 1:15419 N 23RD LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85023-4211
Practice Address - Country:US
Practice Address - Phone:602-675-0678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health