Provider Demographics
NPI:1720336472
Name:HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS
Entity Type:Organization
Organization Name:HEALING EDUCATIONAL ALTERNATIVES FOR DESERVING STUDENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-352-1712
Mailing Address - Street 1:701 S HOWARD AVE
Mailing Address - Street 2:SUITE 106336
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2473
Mailing Address - Country:US
Mailing Address - Phone:239-352-1712
Mailing Address - Fax:
Practice Address - Street 1:8179 N PINE ISLAND RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1543
Practice Address - Country:US
Practice Address - Phone:239-352-1712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health