Provider Demographics
NPI:1558619056
Name:PREFERRED ALTERNATIVE LIVING INC.
Entity type:Organization
Organization Name:PREFERRED ALTERNATIVE LIVING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:FAUSAT
Authorized Official - Middle Name:ABIMBOLA
Authorized Official - Last Name:ADEKUNLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-244-0433
Mailing Address - Street 1:11023 SHETTLESTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-2812
Mailing Address - Country:US
Mailing Address - Phone:832-244-0433
Mailing Address - Fax:832-999-4739
Practice Address - Street 1:11023 SHETTLESTON DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-2812
Practice Address - Country:US
Practice Address - Phone:832-244-0433
Practice Address - Fax:832-999-4739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health