Provider Demographics
NPI:1861010993
Name:MAXWELL ALTERNATIVE RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:MAXWELL ALTERNATIVE RESIDENTIAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROYAL
Authorized Official - Middle Name:BETTIS
Authorized Official - Last Name:MAXWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-724-9856
Mailing Address - Street 1:PO BOX 830208
Mailing Address - Street 2:
Mailing Address - City:TUSKEGEE
Mailing Address - State:AL
Mailing Address - Zip Code:36083-0208
Mailing Address - Country:US
Mailing Address - Phone:334-552-0026
Mailing Address - Fax:
Practice Address - Street 1:104 GAUTIER ST
Practice Address - Street 2:
Practice Address - City:TUSKEGEE
Practice Address - State:AL
Practice Address - Zip Code:36083-2645
Practice Address - Country:US
Practice Address - Phone:334-226-1454
Practice Address - Fax:404-745-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities