Provider Demographics
NPI:1972666733
Name:ALPHA HOME MEDICAL LLC
Entity Type:Organization
Organization Name:ALPHA HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOSELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-874-1183
Mailing Address - Street 1:2700 CITIZENS PKWY
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-4013
Mailing Address - Country:US
Mailing Address - Phone:334-874-1183
Mailing Address - Fax:334-874-1184
Practice Address - Street 1:2700 CITIZENS PKWY
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-4013
Practice Address - Country:US
Practice Address - Phone:334-874-1183
Practice Address - Fax:334-874-1184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL639332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51528398OtherBCBS OF AL PROVIDER
AL5428230001Medicare NSC