Provider Demographics
NPI:1801088489
Name:ALPHA HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:ALPHA HOME HEALTH CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-932-1852
Mailing Address - Street 1:6760 OLD JACKSON HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-9055
Mailing Address - Country:US
Mailing Address - Phone:903-363-9932
Mailing Address - Fax:888-333-8977
Practice Address - Street 1:7512 BROADWAY EXT
Practice Address - Street 2:STE 312
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-9055
Practice Address - Country:US
Practice Address - Phone:405-463-5695
Practice Address - Fax:405-463-5697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7865251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK7865OtherLICENSE