Provider Demographics
NPI:1003953548
Name:ALLIANCE RECOVERY CENTER, INC.
Entity Type:Organization
Organization Name:ALLIANCE RECOVERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NED
Authorized Official - Middle Name:M
Authorized Official - Last Name:ETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-823-0541
Mailing Address - Street 1:209 SWANTON WAY # B
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3271
Mailing Address - Country:US
Mailing Address - Phone:404-377-7669
Mailing Address - Fax:404-377-8536
Practice Address - Street 1:209 SWANTON WAY # B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3271
Practice Address - Country:US
Practice Address - Phone:404-377-7669
Practice Address - Fax:404-377-8536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANTP001000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANTP001000OtherNARCOTIC TREATMENT