Provider Demographics
NPI:1174168207
Name:ALIVE HEALTHCARE SERVICES
Entity type:Organization
Organization Name:ALIVE HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:EDEM
Authorized Official - Last Name:MACGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-221-5373
Mailing Address - Street 1:6133 SILVER ARROWS WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-7411
Mailing Address - Country:US
Mailing Address - Phone:301-221-5373
Mailing Address - Fax:
Practice Address - Street 1:6133 SILVER ARROWS WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-7411
Practice Address - Country:US
Practice Address - Phone:301-221-5373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health