=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447473889
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTERNATIVES LIVING, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 SAINT CHARLES AVE STE. 2543
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70170-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-821-4439
-----------------------------------------------------
Fax | 504-821-4775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 201 SAINT CHARLES AVE STE. 2543
-----------------------------------------------------
City | NEW ORLEANS
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70170-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 504-821-4439
-----------------------------------------------------
Fax | 504-821-4775
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MR. RICKEY WAYNE ROBERSON SR.
-----------------------------------------------------
Credential | M.S.M.
-----------------------------------------------------
Telephone | 504-400-3583
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | 12269
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251C00000X
-----------------------------------------------------
Taxonomy Name | Developmentally Disabled Services Day Training Agency
-----------------------------------------------------
License Number | 12270
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------