Provider Demographics
NPI:1902262694
Name:ALLIANCE HEALTHCARE NORTHEAST, LLC
Entity Type:Organization
Organization Name:ALLIANCE HEALTHCARE NORTHEAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-237-5668
Mailing Address - Street 1:2116 JUSTICE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3618
Mailing Address - Country:US
Mailing Address - Phone:318-237-5668
Mailing Address - Fax:318-742-4096
Practice Address - Street 1:2116 JUSTICE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3618
Practice Address - Country:US
Practice Address - Phone:318-237-5668
Practice Address - Fax:318-742-4096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-11
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health