Provider Demographics
NPI:1295852929
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
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:
Practice Address - Street 1:5950 SIX FORKS RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3895
Practice Address - Country:US
Practice Address - Phone:919-844-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300764BMedicaid
NC8300764JMedicaid
NC8300764GMedicaid