Provider Demographics
NPI:1821878968
Name:ALPHA-OMEGA HOMECARE AND SERVICES, LLC
Entity Type:Organization
Organization Name:ALPHA-OMEGA HOMECARE AND SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-312-0318
Mailing Address - Street 1:10149 DOGWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-4122
Mailing Address - Country:US
Mailing Address - Phone:904-312-0318
Mailing Address - Fax:
Practice Address - Street 1:6028 CHESTER AVE STE 207
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-2285
Practice Address - Country:US
Practice Address - Phone:904-862-7390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No253Z00000XAgenciesIn Home Supportive Care