Provider Demographics
NPI:1922469741
Name:ALPHACARE SUPPORT COORDINATION, LLC
Entity Type:Organization
Organization Name:ALPHACARE SUPPORT COORDINATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VANDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-731-3100
Mailing Address - Street 1:7809 AIRLINE DR
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6439
Mailing Address - Country:US
Mailing Address - Phone:504-731-3100
Mailing Address - Fax:504-731-3103
Practice Address - Street 1:7809 AIRLINE DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6439
Practice Address - Country:US
Practice Address - Phone:504-731-3100
Practice Address - Fax:504-731-3103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203781116251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2342061Medicaid