Provider Demographics
NPI:1699007336
Name:ALPHA OMEGA HOSPICE LLC
Entity Type:Organization
Organization Name:ALPHA OMEGA HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:801-225-1080
Mailing Address - Street 1:250 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4637
Mailing Address - Country:US
Mailing Address - Phone:801-225-1080
Mailing Address - Fax:801-225-1069
Practice Address - Street 1:776 E RIVERSIDE DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6966
Practice Address - Country:US
Practice Address - Phone:801-225-1080
Practice Address - Fax:801-225-1069
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA OMEGA HOSPICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based