Provider Demographics
NPI:1225368236
Name:ALTERNATIVE LIVING SOLUTIONS
Entity Type:Organization
Organization Name:ALTERNATIVE LIVING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TYSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-793-4365
Mailing Address - Street 1:7271 ATTACHE WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-2005
Mailing Address - Country:US
Mailing Address - Phone:770-996-4667
Mailing Address - Fax:
Practice Address - Street 1:7271 ATTACHE WAY
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30296-2005
Practice Address - Country:US
Practice Address - Phone:770-996-4667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-14
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA305R00000X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
No305S00000XManaged Care OrganizationsPoint of Service