=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609046036
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALPHA SUPPORTED LIVING SERVICES, INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2008
-----------------------------------------------------
Last Update Date | 02/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5917 JONES CREEK RD 200 A
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70817-3000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-751-2409
-----------------------------------------------------
Fax | 225-751-2466
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 77710
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70879-7710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-751-2409
-----------------------------------------------------
Fax | 225-751-2466
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COMMUNITY LIAISON
-----------------------------------------------------
Name | PAMELA B, CARTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 225-751-2409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 15003
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------