Basic Information
| Provider Information | |||||||||
| NPI: | 1811122732 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALTERNATIVE FAMILY SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1421 GUERNEVILLE ROAD | ||||||||
| Address2: | SUITE 218 | ||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954037255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075767700 | ||||||||
| FaxNumber: | 7075769700 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 EXECUTIVE PARK BLVD | ||||||||
| Address2: | SUITE 4900 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941343335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156560116 | ||||||||
| FaxNumber: | 4156560117 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2009 | ||||||||
| 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 |