Provider Demographics
NPI:1336189166
Name:ALPHA BRIDGE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:ALPHA BRIDGE HOME HEALTH, LLC
Other - Org Name:GOLDEN CARE HOME HEALTH AGENCY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DELBERT
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-397-4101
Mailing Address - Street 1:1543 LAKELAND HILLS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3246
Mailing Address - Country:US
Mailing Address - Phone:863-937-8370
Mailing Address - Fax:863-937-8398
Practice Address - Street 1:1543 LAKELAND HILLS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3246
Practice Address - Country:US
Practice Address - Phone:863-937-8370
Practice Address - Fax:863-937-8398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992370251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108402Medicare Oscar/Certification
FL108402Medicare Oscar/Certification