Provider Demographics
NPI: | 1760670566 |
---|---|
Name: | ALTERNATIVE LIFESKILLS INC |
Entity Type: | Organization |
Organization Name: | ALTERNATIVE LIFESKILLS INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | DONNA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BROCK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | REGISTERED NURSE MAS |
Authorized Official - Phone: | 606-487-1863 |
Mailing Address - Street 1: | PO BOX 1418 |
Mailing Address - Street 2: | |
Mailing Address - City: | HAZARD |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 41702-1418 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 606-487-1863 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 59 E MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | HAZARD |
Practice Address - State: | KY |
Practice Address - Zip Code: | 41701-1938 |
Practice Address - Country: | US |
Practice Address - Phone: | 606-487-1863 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-10-07 |
Last Update Date: | 2007-10-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
No | 251B00000X | Agencies | Case Management | |
No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
No | 251S00000X | Agencies | Community/Behavioral Health | |
No | 251X00000X | Agencies | Supports Brokerage | |
No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 385H00000X | Respite Care Facility | Respite Care | |
No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |