Provider Demographics
NPI:1417091331
Name:ALPHA HOUSE, INC
Entity Type:Organization
Organization Name:ALPHA HOUSE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COUGHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MPH, MSW
Authorized Official - Phone:412-363-4220
Mailing Address - Street 1:435 SHADY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206
Mailing Address - Country:US
Mailing Address - Phone:412-363-4220
Mailing Address - Fax:412-363-6570
Practice Address - Street 1:435 SHADY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206
Practice Address - Country:US
Practice Address - Phone:412-363-4220
Practice Address - Fax:412-363-6570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA740086251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100731410Medicaid
PA1007314100001Medicaid
PA1007314100002Medicaid