Provider Demographics
NPI:1548750516
Name:ALPHA RESIDENTIAL SERVICES LLC
Entity Type:Organization
Organization Name:ALPHA RESIDENTIAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNA
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKWOSHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:984-232-8887
Mailing Address - Street 1:5842 FARINGDON PL STE 2
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:984-232-8984
Practice Address - Street 1:5842 FARINGDON PL STE 2
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3930
Practice Address - Country:US
Practice Address - Phone:984-232-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-15
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home