Provider Demographics
NPI:1063001634
Name:ALPHA INTEGRATED HEALTHCARE LLC
Entity Type:Organization
Organization Name:ALPHA INTEGRATED HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRAH
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:ARCHER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:970-759-5669
Mailing Address - Street 1:208 W NORTH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3121
Mailing Address - Country:US
Mailing Address - Phone:970-759-5669
Mailing Address - Fax:833-562-2982
Practice Address - Street 1:208 W NORTH ST STE 2
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3121
Practice Address - Country:US
Practice Address - Phone:970-759-5669
Practice Address - Fax:833-562-2982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)