Provider Demographics
NPI:1376136739
Name:ALPHA LIFE MENTAL AND WELLNESS CENTER
Entity Type:Organization
Organization Name:ALPHA LIFE MENTAL AND WELLNESS CENTER
Other - Org Name:ALPHA LIFE MENTAL HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:MRS
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:E
Authorized Official - Last Name:OFOKANSI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:407-410-8621
Mailing Address - Street 1:13506 SUMMERPORT VILLAGE PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-7366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7208 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5200
Practice Address - Country:US
Practice Address - Phone:407-410-8621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health