Provider Demographics
NPI:1437640307
Name:ALPHA INDEPENDENT LIVING INC
Entity Type:Organization
Organization Name:ALPHA INDEPENDENT LIVING INC
Other - Org Name:ALPHA LIVING SOLUTION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MFON
Authorized Official - Middle Name:
Authorized Official - Last Name:ODIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-264-4344
Mailing Address - Street 1:17915 TIMERWALK LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-7890
Mailing Address - Country:US
Mailing Address - Phone:346-264-4344
Mailing Address - Fax:
Practice Address - Street 1:15126 CORONA DEL MAR DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-4308
Practice Address - Country:US
Practice Address - Phone:346-264-4344
Practice Address - Fax:888-420-8897
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA INDEPENDENT LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-25
Last Update Date:2018-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health