Provider Demographics
NPI: | 1811374382 |
---|---|
Name: | EL PASO ALLIANCE, INC. |
Entity Type: | Organization |
Organization Name: | EL PASO ALLIANCE, INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | BEN |
Authorized Official - Middle Name: | GRAY |
Authorized Official - Last Name: | BASS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 915-594-7000 |
Mailing Address - Street 1: | 3501 HUECO AVE |
Mailing Address - Street 2: | MAIL STOP BB |
Mailing Address - City: | EL PASO |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 79903-4312 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 915-594-7000 |
Mailing Address - Fax: | 915-584-8420 |
Practice Address - Street 1: | 3501 HUECO AVE |
Practice Address - Street 2: | MAIL STOP BB |
Practice Address - City: | EL PASO |
Practice Address - State: | TX |
Practice Address - Zip Code: | 79903-4312 |
Practice Address - Country: | US |
Practice Address - Phone: | 915-594-7000 |
Practice Address - Fax: | 915-584-8420 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2015-05-04 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 116 | 324500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |