Provider Demographics
NPI:1043412869
Name:THIRD STREET ALLIANCE
Entity Type:Organization
Organization Name:THIRD STREET ALLIANCE
Other - Org Name:SHARING THE CARING ADULT DAY SERVICES CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAHPAREH
Authorized Official - Middle Name:
Authorized Official - Last Name:FAKHRAIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-258-6271
Mailing Address - Street 1:41 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3642
Mailing Address - Country:US
Mailing Address - Phone:610-258-6271
Mailing Address - Fax:610-258-2112
Practice Address - Street 1:41 N 3RD ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3642
Practice Address - Country:US
Practice Address - Phone:610-258-6271
Practice Address - Fax:610-258-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8698805Medicaid