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
StateLicense IDTaxonomies
TX116324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility