Provider Demographics
NPI:1669624417
Name:ALPHA DELTA FAMILY SERVICES GRP. INC.
Entity type:Organization
Organization Name:ALPHA DELTA FAMILY SERVICES GRP. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:CREWS
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:919-630-6589
Mailing Address - Street 1:7612 NC HWY 49
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7519
Mailing Address - Country:US
Mailing Address - Phone:336-562-5300
Mailing Address - Fax:336-562-5500
Practice Address - Street 1:508 HWY 86 N
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278
Practice Address - Country:US
Practice Address - Phone:919-643-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6603634Medicaid