Provider Demographics
NPI:1144507617
Name:ALTERNATIVES FOR THE OLDER ADULT, INC
Entity type:Organization
Organization Name:ALTERNATIVES FOR THE OLDER ADULT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-277-0167
Mailing Address - Street 1:1803 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-3728
Mailing Address - Country:US
Mailing Address - Phone:309-277-0167
Mailing Address - Fax:309-277-0163
Practice Address - Street 1:1803 7TH ST
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-3728
Practice Address - Country:US
Practice Address - Phone:309-277-0167
Practice Address - Fax:309-277-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILU129503901251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU129503901OtherILLINOIS DEPARTMENT ON AGING