Provider Demographics
NPI:1538984844
Name:MCALISTER
Entity type:Organization
Organization Name:MCALISTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OVERNIGHT MONITOR
Authorized Official - Prefix:
Authorized Official - First Name:DEVRON
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-465-7303
Mailing Address - Street 1:2049 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-4221
Mailing Address - Country:US
Mailing Address - Phone:619-465-7303
Mailing Address - Fax:619-337-3610
Practice Address - Street 1:2049 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-4221
Practice Address - Country:US
Practice Address - Phone:619-465-7303
Practice Address - Fax:619-337-3610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-21
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility