Provider Demographics
NPI:1083829469
Name:ALPHA OMEGA LIFE CARE, INC.
Entity Type:Organization
Organization Name:ALPHA OMEGA LIFE CARE, INC.
Other - Org Name:KENNETH E. FARROW
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:FARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-895-4104
Mailing Address - Street 1:PO BOX 1009
Mailing Address - Street 2:
Mailing Address - City:DELTA JUNCTION
Mailing Address - State:AK
Mailing Address - Zip Code:99737-1009
Mailing Address - Country:US
Mailing Address - Phone:907-895-4104
Mailing Address - Fax:907-895-4143
Practice Address - Street 1:2415 RAPIDS ST.
Practice Address - Street 2:
Practice Address - City:DELTA JUNCTION
Practice Address - State:AK
Practice Address - Zip Code:99737-1009
Practice Address - Country:US
Practice Address - Phone:907-895-4104
Practice Address - Fax:907-895-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK714589251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC2942Medicaid