Provider Demographics
NPI:1477230647
Name:ALPHA GROUP HOME LLC
Entity Type:Organization
Organization Name:ALPHA GROUP HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABDULKADIR
Authorized Official - Middle Name:ISMAIL
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-558-4384
Mailing Address - Street 1:2915 S WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2145
Mailing Address - Country:US
Mailing Address - Phone:612-558-4384
Mailing Address - Fax:612-486-7304
Practice Address - Street 1:2915 S WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55405-2145
Practice Address - Country:US
Practice Address - Phone:612-558-4384
Practice Address - Fax:612-486-7304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care