Provider Demographics
NPI:1083031066
Name:ALPHA SUPPORTED LIVING SERVICES
Entity Type:Organization
Organization Name:ALPHA SUPPORTED LIVING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVENGOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-284-9130
Mailing Address - Street 1:16030 JUANITA WOODINVILLE WAY NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5412
Mailing Address - Country:US
Mailing Address - Phone:206-284-9130
Mailing Address - Fax:425-420-1133
Practice Address - Street 1:16030 JUANITA WOODINVILLE WAY NE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5412
Practice Address - Country:US
Practice Address - Phone:206-284-9130
Practice Address - Fax:425-420-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601138481253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care