Provider Demographics
NPI:1497043327
Name:COMMUNITY BENEFITS CONSORTIUM, INC.
Entity Type:Organization
Organization Name:COMMUNITY BENEFITS CONSORTIUM, INC.
Other - Org Name:ALTERNATE HOME SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OPHELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMMONS-URQUHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-413-7791
Mailing Address - Street 1:1771 E FLAMINGO RD
Mailing Address - Street 2:SUITE B118
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5155
Mailing Address - Country:US
Mailing Address - Phone:702-413-7791
Mailing Address - Fax:702-413-7792
Practice Address - Street 1:1771 E FLAMINGO RD
Practice Address - Street 2:SUITE B118
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5155
Practice Address - Country:US
Practice Address - Phone:702-413-7791
Practice Address - Fax:702-413-7792
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY BENEFITS CONSORTIUM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6079PCS-2251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV42OtherHOME HEALTH
46OtherRESPITE CARE