Provider Demographics
NPI:1609088475
Name:HEALTH EDUCATION ALLIANCE
Entity Type:Organization
Organization Name:HEALTH EDUCATION ALLIANCE
Other - Org Name:HUMBOLDT DEL NORTE INDEPENDANT PRACTICE ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-443-4563
Mailing Address - Street 1:3100 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-2775
Mailing Address - Country:US
Mailing Address - Phone:707-443-0124
Mailing Address - Fax:707-443-2527
Practice Address - Street 1:3100 EDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-2775
Practice Address - Country:US
Practice Address - Phone:707-443-0124
Practice Address - Fax:707-443-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes132700000XDietary & Nutritional Service ProvidersDietary ManagerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ28169ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER