Basic Information
| Provider Information | |||||||||
| NPI: | 1730390162 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTERNATIVE FAMILY SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 131B STONY CIR | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954019507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075767700 | ||||||||
| FaxNumber: | 7075769700 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 ROLAND WAY | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946212034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108393800 | ||||||||
| FaxNumber: | 5108393888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2007 | ||||||||
| LastUpdateDate: | 02/23/2022 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS-AKYEEM | ||||||||
| AuthorizedOfficialFirstName: | MARSHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9162027480 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.S. | ||||||||
| NPICertificationDate: | 02/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 01DA | 05 | CA | MEDICAID | 07H2 | 05 | CA | MEDICAID | 38GG | 05 | CA | MEDICAID |