Provider Demographics
NPI:1710382635
Name:ALPHA HOME CARE CORP
Entity Type:Organization
Organization Name:ALPHA HOME CARE CORP
Other - Org Name:ALPHA HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZURAB
Authorized Official - Middle Name:
Authorized Official - Last Name:KVANTRISHVILI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-485-5967
Mailing Address - Street 1:332 BUSTLETON PIKE FL 3
Mailing Address - Street 2:UNIT B
Mailing Address - City:FEASTERVILLE TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7856
Mailing Address - Country:US
Mailing Address - Phone:215-485-5967
Mailing Address - Fax:215-485-5924
Practice Address - Street 1:332 BUSTLETON PIKE FL 3
Practice Address - Street 2:UNIT B
Practice Address - City:FEASTERVILLE TREVOSE
Practice Address - State:PA
Practice Address - Zip Code:19053-7856
Practice Address - Country:US
Practice Address - Phone:215-485-5967
Practice Address - Fax:215-485-5924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-04
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
PA26183601253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103Medicaid