Provider Demographics
NPI:1679863351
Name:ALTERNATIVE HOME CARE SPECIALISTS, INC.
Entity Type:Organization
Organization Name:ALTERNATIVE HOME CARE SPECIALISTS, INC.
Other - Org Name:I.M.P.A.C. BY ALTERNATIVE HOME CARE SPECIALISTS, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEPHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-0545
Mailing Address - Street 1:1220 ERASTE LANDRY RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3046
Mailing Address - Country:US
Mailing Address - Phone:337-233-0545
Mailing Address - Fax:337-233-2490
Practice Address - Street 1:1531 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-1825
Practice Address - Country:US
Practice Address - Phone:337-233-0545
Practice Address - Fax:337-233-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA102210251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2131672Medicaid