Provider Demographics
NPI:1285859736
Name:ALTERNATIVE LIFESTYLES, INC.
Entity Type:Organization
Organization Name:ALTERNATIVE LIFESTYLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:FLOYD
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1260-463-7079
Mailing Address - Street 1:995 N 250 W
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:IN
Mailing Address - Zip Code:46761-9459
Mailing Address - Country:US
Mailing Address - Phone:260-463-7079
Mailing Address - Fax:
Practice Address - Street 1:995 N 250 W
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-9459
Practice Address - Country:US
Practice Address - Phone:260-463-7079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities