Provider Demographics
NPI:1053589739
Name:ALPHA & OMEGA HOME CARE
Entity type:Organization
Organization Name:ALPHA & OMEGA HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDELON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-722-9442
Mailing Address - Street 1:3024 TOULON RD SE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-7664
Mailing Address - Country:US
Mailing Address - Phone:321-722-9442
Mailing Address - Fax:321-722-9442
Practice Address - Street 1:3024 TOULON RD SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-7664
Practice Address - Country:US
Practice Address - Phone:321-722-9442
Practice Address - Fax:321-722-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906143311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home