Provider Demographics
NPI:1235625690
Name:ALPHA & OMEGA HEALTHCARE LLC
Entity Type:Organization
Organization Name:ALPHA & OMEGA HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-226-9216
Mailing Address - Street 1:3830 WOODRIDGE BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7564
Mailing Address - Country:US
Mailing Address - Phone:513-973-1255
Mailing Address - Fax:513-898-3329
Practice Address - Street 1:3830 WOODRIDGE BLVD STE F
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7564
Practice Address - Country:US
Practice Address - Phone:513-973-1255
Practice Address - Fax:513-898-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0271459Medicaid