Provider Demographics
NPI:1346776879
Name:REDEFINING EXPECTATIONS FOR ALTERNATIVE LIVING
Entity Type:Organization
Organization Name:REDEFINING EXPECTATIONS FOR ALTERNATIVE LIVING
Other - Org Name:REAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:SR
Authorized Official - Credentials:MS PSYCH
Authorized Official - Phone:406-633-4833
Mailing Address - Street 1:217 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-3108
Mailing Address - Country:US
Mailing Address - Phone:406-633-4833
Mailing Address - Fax:406-633-4834
Practice Address - Street 1:217 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3108
Practice Address - Country:US
Practice Address - Phone:406-633-4833
Practice Address - Fax:406-633-4834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0499070Medicaid