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NPI Code Detail

MEDICARE: ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC

MEDICARE: ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC
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
1251S00000XCommunity/Behavioral Health AgencyID

Other Identifiers

General Provider Information

NPI Number : 1750672093
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC
Provider Business Mailing Address
First Line : 1417 N 4TH ST
Second Line :
City : COEUR D ALENE
State : ID
Zip : 83814-3310
Country : US
Telephone Number : 208-292-2188
Fax Number : 208-292-2189
Provider Business Practice Location Address
First Line : 622 W COLLEGE AVE STE 2
Second Line :
City : ST MARIES
State : ID
Zip : 83861-1822
Country : US
Telephone Number : 208-245-4363
Fax Number : 208-245-4349
Authorized Official
Title or Position : OPERATIONS MANAGER
Name : MRS. MICHELLE WOOD
Credential :
Telephone Number : 208-292-2188
Provider Enumeration Date : 04/20/2011
Last Update Date : 04/20/2011

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Directions to “ALTERNATIVE COMMUNITY ENRICHMENT SERVICES, INC ” Practice Location

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