Healthcare Provider Details

I. General information

NPI: 1548414519
Provider Name (Legal Business Name): ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 BANK STREET
WALLACE ID
83873
US

IV. Provider business mailing address

1417 N 4TH STREET
COEUR D ALENE ID
83814
US

V. Phone/Fax

Practice location:
  • Phone: 208-556-0960
  • Fax: 208-752-1048
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 StateID
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number251E00000X
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number251E00000X
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number251S00000X
License Number StateID
# 5
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