Provider Demographics
NPI:1740488014
Name:ALTERNATIVE ADULT CARE
Entity type:Organization
Organization Name:ALTERNATIVE ADULT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGARET
Authorized Official - Middle Name:W
Authorized Official - Last Name:COUSIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:804-427-6966
Mailing Address - Street 1:7193 BROOKING WAY
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-5059
Mailing Address - Country:US
Mailing Address - Phone:804-427-6966
Mailing Address - Fax:
Practice Address - Street 1:7193 BROOKING WAY
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-5059
Practice Address - Country:US
Practice Address - Phone:804-427-6966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACLO-06-1103628311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008730598Medicaid