Provider Demographics
NPI:1245627587
Name:ALLIANT INTERNATIONAL UNIVERSITY
Entity type:Organization
Organization Name:ALLIANT INTERNATIONAL UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTION COUNSELER
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:YADIRA
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-639-0037
Mailing Address - Street 1:335 CALMACE DR
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2317
Mailing Address - Country:US
Mailing Address - Phone:707-639-0037
Mailing Address - Fax:
Practice Address - Street 1:335 CALMACE DR
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-2317
Practice Address - Country:US
Practice Address - Phone:707-639-0037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD9411566324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility