MEDICARE: IPARC ALTERNATIVE LIVING 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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1568311611
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IPARC ALTERNATIVE LIVING LLC

Provider Business Mailing Address
First Line	:	2001 DRYDEN RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-1303
Country	:	US
Telephone Number	:	743-999-4405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 DRYDEN RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-1303
Country	:	US
Telephone Number	:	743-999-4405
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EARNEST A SIDES JR.
Credential	:
Telephone Number	:	743-999-4405

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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