Provider Demographics
NPI:1346692233
Name:ADDICTION HEALING ALLIANCE
Entity Type:Organization
Organization Name:ADDICTION HEALING ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:720-660-7848
Mailing Address - Street 1:10811 SHADOW PINES RD
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8487
Mailing Address - Country:US
Mailing Address - Phone:720-660-7848
Mailing Address - Fax:
Practice Address - Street 1:14991 E HAMPDEN AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3983
Practice Address - Country:US
Practice Address - Phone:720-660-7848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR40692207LA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1679610364OtherMEDICARE NPI
CO52833241Medicaid