Provider Demographics
NPI:1134608136
Name:ALLIANCE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:ALLIANCE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:DONTAE
Authorized Official - Last Name:COLEMAN-LEOPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-253-4922
Mailing Address - Street 1:24505 S AVALON BLVD APT 12
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-1068
Mailing Address - Country:US
Mailing Address - Phone:562-253-4922
Mailing Address - Fax:
Practice Address - Street 1:24505 S AVALON BLVD APT 12
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-1068
Practice Address - Country:US
Practice Address - Phone:562-253-4922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-09
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health