1174735344 NPI number — ALPHA SUPPORTED LIVING SERVICES, INCORPORATED

Table of content: (NPI 1174735344)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174735344 NPI number — ALPHA SUPPORTED LIVING SERVICES, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPHA SUPPORTED LIVING SERVICES, INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174735344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 77710
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70879-7710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-834-8086
Provider Business Mailing Address Fax Number:
504-834-8098

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3401 RIDGELAKE DR
Provider Second Line Business Practice Location Address:
105
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70002-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-834-8086
Provider Business Practice Location Address Fax Number:
504-834-8098
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CARTER
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
B
Authorized Official Title or Position:
COMMUNITY LIAISON
Authorized Official Telephone Number:
504-858-2283

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  PCA7463 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RC7461 . This is a "RESPITE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: SIL7460 . This is a "SIL" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: PCA7463 . This is a "PCA" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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