Provider Demographics
NPI:1760901318
Name:LIVING ALTERNATIVES FO
Entity Type:Organization
Organization Name:LIVING ALTERNATIVES FO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MITZELFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:810-750-4596
Mailing Address - Street 1:300 WHITNEY ST
Mailing Address - Street 2:
Mailing Address - City:DOWAGIAC
Mailing Address - State:MI
Mailing Address - Zip Code:49047-1672
Mailing Address - Country:US
Mailing Address - Phone:269-782-0654
Mailing Address - Fax:269-782-3828
Practice Address - Street 1:300 WHITNEY ST
Practice Address - Street 2:
Practice Address - City:DOWAGIAC
Practice Address - State:MI
Practice Address - Zip Code:49047-1672
Practice Address - Country:US
Practice Address - Phone:269-782-0654
Practice Address - Fax:269-782-3828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1598000549OtherNPI