Provider Demographics
NPI:1669694147
Name:ALTERNATIVE LIFE, INC
Entity type:Organization
Organization Name:ALTERNATIVE LIFE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGIE
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-546-9700
Mailing Address - Street 1:2622 STONE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-7666
Mailing Address - Country:US
Mailing Address - Phone:678-546-9700
Mailing Address - Fax:678-546-9200
Practice Address - Street 1:5624 RAINTREE TRACE
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3014
Practice Address - Country:US
Practice Address - Phone:678-546-9700
Practice Address - Fax:678-546-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA251V00000X, 322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251V00000XAgenciesVoluntary or Charitable
Not Answered322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children