Provider Demographics
NPI:1063682110
Name:ALPHA HOME HEALTH/MEDICAL
Entity Type:Organization
Organization Name:ALPHA HOME HEALTH/MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ARASE
Authorized Official - Last Name:EREYI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-721-1575
Mailing Address - Street 1:8147 DELMAR BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-3735
Mailing Address - Country:US
Mailing Address - Phone:314-721-1575
Mailing Address - Fax:314-721-0545
Practice Address - Street 1:8147 DELMAR BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-3735
Practice Address - Country:US
Practice Address - Phone:314-721-1575
Practice Address - Fax:314-721-0545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1063682110Medicaid
MO1174700116Medicaid