Provider Demographics
NPI:1356217343
Name:ALPHA AND OMEGA STAR LLC
Entity type:Organization
Organization Name:ALPHA AND OMEGA STAR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-564-4971
Mailing Address - Street 1:2356 CALENDAR CT
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7626
Mailing Address - Country:US
Mailing Address - Phone:817-564-4971
Mailing Address - Fax:281-729-8173
Practice Address - Street 1:2356 CALENDAR CT
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-7626
Practice Address - Country:US
Practice Address - Phone:817-564-4971
Practice Address - Fax:281-729-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-15
Last Update Date:2025-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty