Provider Demographics
NPI:1407341175
Name:ALPHA-OHMS HEALTHCARE, LLC
Entity Type:Organization
Organization Name:ALPHA-OHMS HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHINEDU
Authorized Official - Middle Name:
Authorized Official - Last Name:UBANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-655-9155
Mailing Address - Street 1:5409 THE VYNE AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8736
Mailing Address - Country:US
Mailing Address - Phone:404-655-9155
Mailing Address - Fax:404-600-5396
Practice Address - Street 1:5409 THE VYNE AVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8736
Practice Address - Country:US
Practice Address - Phone:404-655-9155
Practice Address - Fax:404-600-5396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060-R-1623251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003205291AMedicaid
GA003204165BMedicaid
GA003204165AMedicaid