Provider Demographics
NPI:1023347275
Name:ALLIANCE FOR SELF-DETERMINATION, INC.
Entity type:Organization
Organization Name:ALLIANCE FOR SELF-DETERMINATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSWALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-638-1979
Mailing Address - Street 1:PO BOX 21772
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7053
Mailing Address - Country:US
Mailing Address - Phone:307-638-1979
Mailing Address - Fax:
Practice Address - Street 1:419 W 18TH ST
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-4331
Practice Address - Country:US
Practice Address - Phone:307-638-1979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care