Provider Demographics
NPI:1801233408
Name:ALPHA 1306 LLC
Entity Type:Organization
Organization Name:ALPHA 1306 LLC
Other - Org Name:ALPHA CARE RESIDENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-502-0323
Mailing Address - Street 1:1088 GRANDVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4003
Mailing Address - Country:US
Mailing Address - Phone:561-502-0323
Mailing Address - Fax:561-282-6530
Practice Address - Street 1:1088 GRANDVIEW CIR
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4003
Practice Address - Country:US
Practice Address - Phone:561-502-0323
Practice Address - Fax:561-282-6530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-23
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12303310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL12303OtherASSISTED LIVING FACILITY