Healthcare Provider Details

I. General information

NPI: 1225368236
Provider Name (Legal Business Name): ALTERNATIVE LIVING SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 01/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7271 ATTACHE WAY
RIVERDALE GA
30296-2005
US

IV. Provider business mailing address

7271 ATTACHE WAY
RIVERDALE GA
30296-2005
US

V. Phone/Fax

Practice location:
  • Phone: 770-996-4667
  • Fax:
Mailing address:
  • Phone: 770-996-4667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number StateGA

VIII. Authorized Official

Name: MS. VIVIAN TYSON
Title or Position: ASST. DIRECTOR
Credential:
Phone: 678-793-4365