Provider Demographics
NPI:1548699028
Name:ALPHA & OMEGA EMPOWERMENT FOUNDATION
Entity type:Organization
Organization Name:ALPHA & OMEGA EMPOWERMENT FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-433-1128
Mailing Address - Street 1:2813 SHADBLOW LN UNIT 1306
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-3180
Mailing Address - Country:US
Mailing Address - Phone:843-433-1128
Mailing Address - Fax:
Practice Address - Street 1:2813 SHADBLOW LN UNIT 1306
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29170-3180
Practice Address - Country:US
Practice Address - Phone:843-433-1128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
000000000305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service