Provider Demographics
NPI:1306839972
Name:ALPHA INC
Entity Type:Organization
Organization Name:ALPHA INC
Other - Org Name:GOLDEN ACRES MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:METZGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-652-3117
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:1ST EAST MAIN
Mailing Address - City:CARRINGTON
Mailing Address - State:ND
Mailing Address - Zip Code:58421-0261
Mailing Address - Country:US
Mailing Address - Phone:701-652-3117
Mailing Address - Fax:701-652-3118
Practice Address - Street 1:1ST EAST MAIN
Practice Address - Street 2:
Practice Address - City:CARRINGTON
Practice Address - State:ND
Practice Address - Zip Code:58421-0261
Practice Address - Country:US
Practice Address - Phone:701-652-3117
Practice Address - Fax:701-652-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1010A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND030008Medicaid
ND24570OtherBLUECROSSBLUESHIELDND
ND24570OtherBLUECROSSBLUESHIELDND