1235508615 NPI number — MCALISTER INSTITUTE FOR TREATMENT AND EDUCATION, INC.

Table of content: MRS. NATHALIE EZEUDU NP (NPI 1437900388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235508615 NPI number — MCALISTER INSTITUTE FOR TREATMENT AND EDUCATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCALISTER INSTITUTE FOR TREATMENT AND EDUCATION, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DALE AVENUE TEEN RECOVERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235508615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 N JOHNSON AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
EL CAJON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92020-1651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-442-0277
Provider Business Mailing Address Fax Number:
619-442-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4495 DALE AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LA MESA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91941-6206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-465-4436
Provider Business Practice Location Address Fax Number:
619-465-4456
Provider Enumeration Date:
09/16/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MCALISTER
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
AUDREY
Authorized Official Title or Position:
FOUNDER AND CEO
Authorized Official Telephone Number:
619-442-0277

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 378558 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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