Provider Demographics
NPI:1679104673
Name:DYNAMIC ALTERNATIVE SERVICES
Entity type:Organization
Organization Name:DYNAMIC ALTERNATIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMOAKOHENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-365-9855
Mailing Address - Street 1:171 BROOK ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2505
Mailing Address - Country:US
Mailing Address - Phone:603-365-9855
Mailing Address - Fax:
Practice Address - Street 1:1328 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3651
Practice Address - Country:US
Practice Address - Phone:207-289-8706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-29
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities