Provider Demographics
NPI:1770808636
Name:ALPHACARE HOME HEALTH AGENCY INC
Entity type:Organization
Organization Name:ALPHACARE HOME HEALTH AGENCY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:I
Authorized Official - Last Name:PUKHOVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-600-4547
Mailing Address - Street 1:214 LINCOLN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1347
Mailing Address - Country:US
Mailing Address - Phone:617-600-4547
Mailing Address - Fax:
Practice Address - Street 1:214 LINCOLN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1347
Practice Address - Country:US
Practice Address - Phone:617-600-4547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-05
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253J00000X
MA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253J00000XAgenciesFoster Care Agency