Provider Demographics
NPI:1730281213
Name:ALPHA HEALTHCARE GROUP, LLC
Entity Type:Organization
Organization Name:ALPHA HEALTHCARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEYINKA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADEPOJU
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-499-5216
Mailing Address - Street 1:6738 DOGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4122
Mailing Address - Country:US
Mailing Address - Phone:410-499-5216
Mailing Address - Fax:410-944-8751
Practice Address - Street 1:6738 DOGWOOD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4122
Practice Address - Country:US
Practice Address - Phone:410-499-5216
Practice Address - Fax:410-944-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-04
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD388PMedicare PIN
MD388P765GMedicare PIN