Provider Demographics
NPI:1295069185
Name:PREFERRED ALTERNATIVES OF MISSOURI, INC
Entity type:Organization
Organization Name:PREFERRED ALTERNATIVES OF MISSOURI, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:910-391-6996
Mailing Address - Street 1:P.O. BOX 696
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28335
Mailing Address - Country:US
Mailing Address - Phone:910-391-6996
Mailing Address - Fax:
Practice Address - Street 1:1060 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3373
Practice Address - Country:US
Practice Address - Phone:636-940-6900
Practice Address - Fax:636-940-6940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities