Provider Demographics
NPI:1790862563
Name:ALTERNATIVES FOR LIFE
Entity Type:Organization
Organization Name:ALTERNATIVES FOR LIFE
Other - Org Name:A FULL LIFE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-762-5433
Mailing Address - Street 1:9297 N GOVERNMENT WAY STE C
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-9290
Mailing Address - Country:US
Mailing Address - Phone:208-762-5433
Mailing Address - Fax:208-209-0007
Practice Address - Street 1:8601 W EMERALD ST STE 100
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8209
Practice Address - Country:US
Practice Address - Phone:208-342-1222
Practice Address - Fax:208-375-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV10050096Medicaid