Provider Demographics
NPI:1609046036
Name:ALPHA SUPPORTED LIVING SERVICES, INCORPORATED
Entity Type:Organization
Organization Name:ALPHA SUPPORTED LIVING SERVICES, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY LIAISON
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:B,
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-751-2409
Mailing Address - Street 1:PO BOX 77710
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70879-7710
Mailing Address - Country:US
Mailing Address - Phone:225-751-2409
Mailing Address - Fax:225-751-2466
Practice Address - Street 1:5917 JONES CREEK RD
Practice Address - Street 2:200 A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70817-3000
Practice Address - Country:US
Practice Address - Phone:225-751-2409
Practice Address - Fax:225-751-2466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15003251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA15003OtherLICENSE