Provider Demographics
NPI:1326326869
Name:ALTERNATIVE LIVING, INC.
Entity Type:Organization
Organization Name:ALTERNATIVE LIVING, INC.
Other - Org Name:TWIN CITIES PAVILION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOVEJOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-833-9165
Mailing Address - Street 1:207 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548
Mailing Address - Country:US
Mailing Address - Phone:850-833-9165
Mailing Address - Fax:950-833-9389
Practice Address - Street 1:1053 JOHN SIMS PARKWAY
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578
Practice Address - Country:US
Practice Address - Phone:850-833-9212
Practice Address - Fax:850-833-9389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL5462310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL676877601Medicaid