Provider Demographics
NPI:1083383152
Name:ALTERNATIVE LIFE LLC
Entity Type:Organization
Organization Name:ALTERNATIVE LIFE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:CORALIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:787-435-2321
Mailing Address - Street 1:URB. VILLA ESPANA CALLE LAS MERCEDES P58
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961
Mailing Address - Country:US
Mailing Address - Phone:787-435-2321
Mailing Address - Fax:
Practice Address - Street 1:CARR. 833 KM 12.2 BARRIO SANTA ROSA III
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969
Practice Address - Country:US
Practice Address - Phone:787-435-2321
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty