Provider Demographics
NPI:1548211907
Name:ALPHA OMEGA HEALTH, INC.
Entity type:Organization
Organization Name:ALPHA OMEGA HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:HORNE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-844-1008
Mailing Address - Street 1:5950 SIX FORKS RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3895
Mailing Address - Country:US
Mailing Address - Phone:919-844-1008
Mailing Address - Fax:919-844-0042
Practice Address - Street 1:129 SKYVIEW CIR
Practice Address - Street 2:
Practice Address - City:SPRUCE PINE
Practice Address - State:NC
Practice Address - Zip Code:28777-9518
Practice Address - Country:US
Practice Address - Phone:828-765-0037
Practice Address - Fax:828-765-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0012961041C0700X
251C00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2335034AOtherMEDICARE GROUP
NC6106394Medicaid
NC6005869Medicaid
NC8300751BMedicaid
NC8300751GMedicaid
NC6004036Medicaid
NC286723BOtherMEDICARE - JOE