=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457734360
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALTERNATIVES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2015
-----------------------------------------------------
Last Update Date | 07/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 148 HIGHVIEW ST
-----------------------------------------------------
City | WATERBURY
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-272-4009
-----------------------------------------------------
Fax | 203-272-4077
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 766
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410-0766
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-272-4009
-----------------------------------------------------
Fax | 203-272-4077
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. KELLY P BRAGDON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 203-272-4009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 315P00000X
-----------------------------------------------------
Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------