Provider Demographics
NPI:1972121762
Name:ENVIRONMENTAL ALTERNATIVES SUSANVILLE
Entity Type:Organization
Organization Name:ENVIRONMENTAL ALTERNATIVES SUSANVILLE
Other - Org Name:EA FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-283-3330
Mailing Address - Street 1:2003 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4501
Mailing Address - Country:US
Mailing Address - Phone:530-257-6616
Mailing Address - Fax:
Practice Address - Street 1:2003 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130-4501
Practice Address - Country:US
Practice Address - Phone:530-257-6616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ENVIRONMENTAL ALTERNATIVES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-08
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251X00000XAgenciesSupports Brokerage