Provider Demographics
NPI:1790774636
Name:ALPHA OMEGA HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:ALPHA OMEGA HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:MCCRACKEN
Authorized Official - Last Name:STOTTS
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:936-447-2900
Mailing Address - Street 1:10461 COMMERCE ROW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-3274
Mailing Address - Country:US
Mailing Address - Phone:936-447-2900
Mailing Address - Fax:936-447-2999
Practice Address - Street 1:10461 COMMERCE ROW
Practice Address - Street 2:SUITE 101
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-3274
Practice Address - Country:US
Practice Address - Phone:936-447-2900
Practice Address - Fax:936-447-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008846251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165287701Medicaid
TX165287701Medicaid