Provider Demographics
NPI:1629640750
Name:SANE, ALISA ANA (MALBSWCHCCLC)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:ANA
Last Name:SANE
Suffix:
Gender:F
Credentials:MALBSWCHCCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11302 MEMPHIS ARLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9315
Mailing Address - Country:US
Mailing Address - Phone:901-610-9266
Mailing Address - Fax:
Practice Address - Street 1:11302 MEMPHIS ARLINGTON RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-9315
Practice Address - Country:US
Practice Address - Phone:901-610-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty