Healthcare Provider Details

I. General information

NPI: 1093935728
Provider Name (Legal Business Name): ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 05/10/2011
Certification Date:
Deactivation Date: 03/09/2011
Reactivation Date: 05/02/2011

III. Provider practice location address

1417 N 4TH STREET
COEUR D ALENE ID
83814
US

IV. Provider business mailing address

1417 N 4TH STREET
COEUR D ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-292-2188
  • Fax: 208-292-2189
Mailing address:
  • Phone: 208-292-2188
  • Fax: 208-292-2189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE WOOD
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 208-292-2188