Provider Demographics
NPI:1083798771
Name:ALLIANCE TREATMENT CENTER
Entity Type:Organization
Organization Name:ALLIANCE TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MURADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-826-1358
Mailing Address - Street 1:35 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1312
Mailing Address - Country:US
Mailing Address - Phone:860-229-8887
Mailing Address - Fax:860-229-8886
Practice Address - Street 1:121 W AVON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3506
Practice Address - Country:US
Practice Address - Phone:860-673-6115
Practice Address - Fax:860-675-7433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT100OtherANTHEM PROV. NUMBER HMO
CTCTGA000469OtherSAGA PROVIDER NUMBER
CT50BOtherANTHEM PROV. NUMBER
CTB00537OtherSAGA GROUP LOCATION#
CT50BOtherANTHEM PROV. NUMBER