Provider Demographics
NPI:1790111805
Name:ALPHA-CARE HEALTH PROFESSIONALS, LLC
Entity Type:Organization
Organization Name:ALPHA-CARE HEALTH PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:LINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-398-4100
Mailing Address - Street 1:PO BOX 62
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61824-0062
Mailing Address - Country:US
Mailing Address - Phone:217-398-4100
Mailing Address - Fax:
Practice Address - Street 1:6919 N KNOXVILLE AVE STE 102
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-2817
Practice Address - Country:US
Practice Address - Phone:309-691-3032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA-CARE HEALTH PROEFESSIONALS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1010432251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health