Provider Demographics
NPI:1477944221
Name:ALPHA LIFE, LLC
Entity Type:Organization
Organization Name:ALPHA LIFE, LLC
Other - Org Name:PREMIER PROFESSIONAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-499-2050
Mailing Address - Street 1:3351 CLAYSTONE ST SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5794
Mailing Address - Country:US
Mailing Address - Phone:616-499-2050
Mailing Address - Fax:616-499-2070
Practice Address - Street 1:3351 CLAYSTONE ST SE
Practice Address - Street 2:SUITE 102
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5794
Practice Address - Country:US
Practice Address - Phone:616-499-2050
Practice Address - Fax:616-499-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health