Provider Demographics
NPI:1821232802
Name:ALPHA ONE
Entity Type:Organization
Organization Name:ALPHA ONE
Other - Org Name:ATTENDANT SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZGIBBONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-767-2189
Mailing Address - Street 1:127 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-2647
Mailing Address - Country:US
Mailing Address - Phone:207-767-2189
Mailing Address - Fax:207-799-8346
Practice Address - Street 1:127 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2647
Practice Address - Country:US
Practice Address - Phone:207-767-2189
Practice Address - Fax:207-767-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME110660000Medicaid
ME431733401Medicaid
ME110660100Medicaid
ME431733400Medicaid