1326326869 NPI number — ALTERNATIVE LIVING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326326869 NPI number — ALTERNATIVE LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALTERNATIVE LIVING, INC.
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:
6
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:
1326326869
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 HOSPITAL DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WALTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-833-9165
Provider Business Mailing Address Fax Number:
950-833-9389

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1053 JOHN SIMS PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NICEVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-833-9212
Provider Business Practice Location Address Fax Number:
850-833-9389
Provider Enumeration Date:
08/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOVEJOY
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
850-833-9165

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  AL5462 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 676877601 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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