Provider Demographics
NPI:1942518121
Name:ALLIANT INTERNATIONAL UNIVERSITY
Entity Type:Organization
Organization Name:ALLIANT INTERNATIONAL UNIVERSITY
Other - Org Name:ENCINAL HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILNES
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:510-628-9065
Mailing Address - Street 1:1440 BROADWAY, SUITE 610
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1568
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3246
Practice Address - Country:US
Practice Address - Phone:510-748-4023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-21
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health