Provider Demographics
NPI:1508376955
Name:ALPHA RESIDENTIAL INC
Entity Type:Organization
Organization Name:ALPHA RESIDENTIAL INC
Other - Org Name:SAN BERNARDINO HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:OKORAFOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-629-1829
Mailing Address - Street 1:PO BOX 2220
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91769-2220
Mailing Address - Country:US
Mailing Address - Phone:909-815-1129
Mailing Address - Fax:909-622-2090
Practice Address - Street 1:692 SAN BERNARDINO AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3244
Practice Address - Country:US
Practice Address - Phone:909-620-2585
Practice Address - Fax:909-622-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550002479315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities