Provider Demographics
NPI:1619326097
Name:SPECIALIZED ALTERNATIVES FOR FAMILY AND YOUTH
Entity Type:Organization
Organization Name:SPECIALIZED ALTERNATIVES FOR FAMILY AND YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERVENTION SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PACK
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:419-222-1527
Mailing Address - Street 1:407 HAMILTON RD APT 3
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-1153
Mailing Address - Country:US
Mailing Address - Phone:419-302-5292
Mailing Address - Fax:
Practice Address - Street 1:658 W MARKET ST STE 101
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5604
Practice Address - Country:US
Practice Address - Phone:419-222-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1101026251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health