Provider Demographics
NPI:1881830560
Name:ALPHA ONE STAFFING, LLC
Entity type:Organization
Organization Name:ALPHA ONE STAFFING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ADM./ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-399-9627
Mailing Address - Street 1:416 SOUTH MAIN ST.
Mailing Address - Street 2:SUITE-G
Mailing Address - City:MALUDIN
Mailing Address - State:SC
Mailing Address - Zip Code:29662
Mailing Address - Country:US
Mailing Address - Phone:864-399-9627
Mailing Address - Fax:
Practice Address - Street 1:416 S MAIN ST
Practice Address - Street 2:SUITE- G
Practice Address - City:MAULDIN
Practice Address - State:SC
Practice Address - Zip Code:29662-2260
Practice Address - Country:US
Practice Address - Phone:864-399-9627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-30
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCEX0850253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCEX0850Medicaid