| NPI | 1740540947 |
|---|---|
| Former Legal Business Name | ALPHA & OMEGA RESIDENTIAL, LLC |
| Entity Type | Organization |
| Authorized Contact | DERRICK C JOHNSON CEO 775-857-9599 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: NV E0146102012-5) |
| Enumeration Date | 2012-05-22 |
| Last Update Date | 2017-10-10 |