Provider Demographics
NPI:1093935728
Name:ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC.
Entity Type:Organization
Organization Name:ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC.
Other - Org Name:ACES COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-292-2188
Mailing Address - Street 1:1417 N 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-292-2188
Mailing Address - Fax:208-292-2189
Practice Address - Street 1:1417 N 4TH STREET
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814
Practice Address - Country:US
Practice Address - Phone:208-292-2188
Practice Address - Fax:208-292-2189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2011-05-10
Deactivation Date:2011-03-09
Deactivation Code:
Reactivation Date:2011-05-02
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806431100OtherCDA-MHC