Provider Demographics
NPI:1669260808
Name:ALICIA'S PLACE
Entity type:Organization
Organization Name:ALICIA'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:CHARLENE
Authorized Official - Last Name:VAN CLEVE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:715-902-0848
Mailing Address - Street 1:501 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:CRANDON
Mailing Address - State:WI
Mailing Address - Zip Code:54520-1673
Mailing Address - Country:US
Mailing Address - Phone:715-902-0848
Mailing Address - Fax:262-661-2206
Practice Address - Street 1:605 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:CRANDON
Practice Address - State:WI
Practice Address - Zip Code:54520-1703
Practice Address - Country:US
Practice Address - Phone:715-902-0848
Practice Address - Fax:262-661-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care