Provider Demographics
NPI:1699135103
Name:ALTERNATIVE ADULT DAY CARE LLC
Entity type:Organization
Organization Name:ALTERNATIVE ADULT DAY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:586-200-5606
Mailing Address - Street 1:23600 HARPER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1445
Mailing Address - Country:US
Mailing Address - Phone:586-200-5606
Mailing Address - Fax:586-200-5608
Practice Address - Street 1:23600 HARPER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1445
Practice Address - Country:US
Practice Address - Phone:586-200-5606
Practice Address - Fax:586-200-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016094103T00000X
MI6801090472104100000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty