Provider Demographics
NPI:1710196134
Name:THE EDUCATIONAL ALLIANCE
Entity Type:Organization
Organization Name:THE EDUCATIONAL ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:MELISSA
Authorized Official - Last Name:MARABLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-395-4418
Mailing Address - Street 1:197 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-5507
Mailing Address - Country:US
Mailing Address - Phone:646-395-4280
Mailing Address - Fax:
Practice Address - Street 1:25-29 AVENUE D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-6935
Practice Address - Country:US
Practice Address - Phone:212-780-5475
Practice Address - Fax:212-780-5474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080610221324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY080610221OtherOASAS LICENSE