Provider Demographics
NPI:1053897132
Name:ALPHA BEHAVIORAL HEALTH SERVICES
Entity type:Organization
Organization Name:ALPHA BEHAVIORAL HEALTH SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VANDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-731-3100
Mailing Address - Street 1:7809 AIRLINE DR STE 308
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-6441
Mailing Address - Country:US
Mailing Address - Phone:504-731-3100
Mailing Address - Fax:504-731-3103
Practice Address - Street 1:201 ST. CHARLES AVENUE
Practice Address - Street 2:SUITE 2509
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70170-1000
Practice Address - Country:US
Practice Address - Phone:504-754-6950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHACARE SUPPORT COORDINATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783802251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health