Provider Demographics
NPI:1710046107
Name:AWAKENED ALTERNATIVES INC
Entity Type:Organization
Organization Name:AWAKENED ALTERNATIVES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:708-748-1520
Mailing Address - Street 1:2200 GRANT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46404-3439
Mailing Address - Country:US
Mailing Address - Phone:219-944-9910
Mailing Address - Fax:219-944-9920
Practice Address - Street 1:2200 GRANT ST
Practice Address - Street 2:STE 102
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-3439
Practice Address - Country:US
Practice Address - Phone:219-944-9910
Practice Address - Fax:219-944-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN157472Medicare ID - Type UnspecifiedINDIANA MEDICARE NUMBER