Provider Demographics
NPI:1194852681
Name:ALPHA OMEGA HEALTH, INC
Entity Type:Organization
Organization Name:ALPHA OMEGA HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-844-1008
Mailing Address - Street 1:5950 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3895
Mailing Address - Country:US
Mailing Address - Phone:919-844-1008
Mailing Address - Fax:919-844-0042
Practice Address - Street 1:1260 COLLEGE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2700
Practice Address - Country:US
Practice Address - Phone:336-667-5111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302001BOtherMEDICAID COMM. SUPPORT
NC6106394Medicaid