MEDICARE: ALTERNATIVE HOME CARE SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		MI

General Provider Information

NPI Number	:	1558485078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERNATIVE HOME CARE SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	4320 CORTLAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-1556
Country	:	US
Telephone Number	:	313-491-5525
Fax Number	:	313-491-5523

Provider Business Practice Location Address
First Line	:	4320 CORTLAND ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48204-1556
Country	:	US
Telephone Number	:	313-491-5525
Fax Number	:	313-491-5523

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLOTTE ANN LOGAN
Credential	:	MD
Telephone Number	:	313-575-2317

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

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