Provider Demographics
NPI:1982928073
Name:ALPHA COMMUNITY SUPPORT SERVICES, LLC
Entity Type:Organization
Organization Name:ALPHA COMMUNITY SUPPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:ELLERBE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, QP
Authorized Official - Phone:910-410-0459
Mailing Address - Street 1:415 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-3818
Mailing Address - Country:US
Mailing Address - Phone:910-410-0459
Mailing Address - Fax:910-410-0653
Practice Address - Street 1:415 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3818
Practice Address - Country:US
Practice Address - Phone:910-410-0459
Practice Address - Fax:910-410-0653
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA COMMUNITY SUPPORT SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8302773Medicaid