Provider Demographics
NPI:1740669753
Name:1ST ALLIANCE SERVICE COORDINATORS
Entity type:Organization
Organization Name:1ST ALLIANCE SERVICE COORDINATORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-247-2440
Mailing Address - Street 1:113 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:AMITE
Mailing Address - State:LA
Mailing Address - Zip Code:70422-2715
Mailing Address - Country:US
Mailing Address - Phone:985-247-2440
Mailing Address - Fax:
Practice Address - Street 1:113 W OAK ST
Practice Address - Street 2:
Practice Address - City:AMITE
Practice Address - State:LA
Practice Address - Zip Code:70422-2715
Practice Address - Country:US
Practice Address - Phone:985-247-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management