Organization
ALPHA ADVANTAGE MCO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JERETHA MARBURY (CEO)
(253) 468-7914
Entity
Organization
Contact information
Practice address
6108 COMMUNITY PL SW, LAKEWOOD, WA 98499-2447
(253) 468-7914
Mailing address
PO BOX 112243, TACOMA, WA 98411-2243
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
602187014
WA
251X00000X
Supports Brokerage Agency
602187014
WA
302R00000X
Health Maintenance Organization
602187014
WA
332BC3200X
Customized Equipment (DME)
Primary
602187014
WA
347E00000X
Transportation Broker
602187014
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
146954
—
WA
Enumeration date
12/02/2011
Last updated
12/02/2011
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