Omicron Alpha LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

OMICRON ALPHA LLC

Practice address

2761 Allied St FL 1
Green Bay, WI 54304-5501

Phone

(650) 665-1405

NPI assigned

Jun 20, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ibrahim Budul

Title

Manager

Phone

(650) 665-1405

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1801571534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2761 ALLIED ST FL 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045501",
            "telephone_number": "650-665-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2761 ALLIED ST FL 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045501",
            "telephone_number": "650-665-1405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OMICRON ALPHA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "BUDUL",
        "authorized_official_first_name": "IBRAHIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "650-665-1405"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.