Provider Demographics
NPI:1033585765
Name:ALLIANCE HOUSE INC
Entity Type:Organization
Organization Name:ALLIANCE HOUSE INC
Other - Org Name:ALLIANCE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:801-486-5012
Mailing Address - Street 1:1724 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-1912
Mailing Address - Country:US
Mailing Address - Phone:801-486-5012
Mailing Address - Fax:
Practice Address - Street 1:1724 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-1912
Practice Address - Country:US
Practice Address - Phone:801-486-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1033585765Medicaid