Provider Demographics
| NPI: | 1760670566 |
|---|---|
| Name: | ALTERNATIVE LIFESKILLS INC |
| Entity type: | Organization |
| Organization Name: | ALTERNATIVE LIFESKILLS INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | DONNA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | BROCK |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | REGISTERED NURSE MAS |
| Authorized Official - Phone: | 606-487-1863 |
| Mailing Address - Street 1: | PO BOX 1418 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | HAZARD |
| Mailing Address - State: | KY |
| Mailing Address - Zip Code: | 41702-1418 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 606-487-1863 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 59 E MAIN ST |
| Practice Address - Street 2: | |
| Practice Address - City: | HAZARD |
| Practice Address - State: | KY |
| Practice Address - Zip Code: | 41701-1938 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 606-487-1863 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2007-10-07 |
| Last Update Date: | 2007-10-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| No | 251B00000X | Agencies | Case Management | |
| No | 251C00000X | Agencies | Day Training, Developmentally Disabled Services | |
| No | 251S00000X | Agencies | Community/Behavioral Health | |
| No | 251X00000X | Agencies | Supports Brokerage | |
| No | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
| No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
| No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
| No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
| No | 385H00000X | Respite Care Facility | Respite Care | |
| No | 385HR2050X | Respite Care Facility | Respite Care | Respite Care Camp |
| No | 385HR2055X | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child |
| No | 385HR2060X | Respite Care Facility | Respite Care | Respite Care, Intellectual and/or Developmental Disabilities, Child |
| No | 385HR2065X | Respite Care Facility | Respite Care | Respite Care, Physical Disabilities, Child |
